In a cluster randomized trial, Beth Kangwana and colleagues find that provision of subsidized packs of the malaria therapy artemether-lumefantrine to shops more than doubled the proportion of children with fever who received drugs promptly

A Noor

A Rowe

A Talisuna

Abdisalan M. Noor

AM Noor

Andrew J. Nyandigisi

B Kangwana

B Wasunna

BB Kangwana

Beth P. Kangwana

C Fogg

C Goodman

C Robinson

Catherine A. Goodman

CG Victora

CW Gitonga

D Atkins

D Filmer

D Zurovac

E Depoortere

F Pagnoni

F Smith

F Wafula

Greg W. Fegan

H Hopkins

HA Williams

IO Ajayi

J Chuma

J Njogu

James E. Todd

Jayesh Pandit

JP Habicht

JP Vandenbroucke

LA Smith

N Beer

O Sabot

OJ Sabot

R Laxminarayan

RJ Hayes

Robert W. Snow

S Kedenge

S Yeung

Sarah V. Kedenge

SC McCombie

Simon Brooker

SP Kachur

Stephen John Rogerson

U D'Alessandro

Victor A. Alegana

VM Marsh

PLoS Medicine

English

PubMed

BackgroundIt has been proposed that artemisinin-based combination therapy (ACT) be subsidised in the private sector in order to improve affordability and access. This study in western Kenya aimed to evaluate the impact of providing subsidized artemether-lumefantrine (AL) through retail providers on the coverage of prompt, effective antimalarial treatment for febrile children aged 3-59 months.Methods and findingsWe used a cluster-randomized, controlled design with nine control and nine intervention sublocations, equally distributed across three districts in western Kenya. Cross-sectional household surveys were conducted before and after the delivery of the intervention. The intervention comprised provision of subsidized packs of paediatric ACT to retail outlets, training of retail outlet staff, and community awareness activities. The primary outcome was defined as the proportion of children aged 3-59 months reporting fever in the past 2 weeks who started treatment with AL on the same day or following day of fever onset. Data were collected using structured questionnaires and analyzed based on cluster-level summaries, comparing control to intervention arms, while adjusting for other covariates. Data were collected on 2,749 children in the target age group at baseline and 2,662 at follow-up. 29% of children experienced fever within 2 weeks before the interview. At follow-up, the percentage of children receiving AL on the day of fever or the following day had risen by 14.6% points in the control arm (from 5.3% [standard deviation (SD): 3.2%] to 19.9% [SD: 10.0%]) and 40.2% points in the intervention arm (from 4.7% [SD: 3.4%] to 44.9% [SD: 11.7%]). The percentage of children receiving AL was significantly greater in the intervention arm at follow-up, with a difference between the arms of 25.0% points (95% confidence interval [CI]: 14.1%, 35.9%; unadjusted p = 0.0002, adjusted p = 0.0001). No significant differences were observed between arms in the proportion of caregivers who sought treatment for their child's fever by source, or in the child's adherence to AL.ConclusionsSubsidizing ACT in the retail sector can significantly increase ACT coverage for reported fevers in rural areas. Further research is needed on the impact and cost-effectiveness of such subsidy programmes at a national scale.Trial registrationCurrent Controlled Trials ISRCTN59275137 and Kenya Pharmacy and Poisons Board Ethical Committee for Clinical Trials PPB/ECCT/08/07

Beth P Kangwana

Sarah V Kedenge

Abdisalan M Noor

Victor A Alegana

Andrew J Nyandigisi

Greg W Fegan

James E Todd

Robert W Snow

Catherine A Goodman

Directory of Open Access Journals

The impact of retail-sector delivery of artemether-lumefantrine on malaria treatment of children under five in Kenya: a cluster randomized controlled trial.

BACKGROUND: It has been proposed that artemisinin-based combination therapy (ACT) be subsidised in the private sector in order to improve affordability and access. This study in western Kenya aimed to evaluate the impact of providing subsidized artemether-lumefantrine (AL) through retail providers on the coverage of prompt, effective antimalarial treatment for febrile children aged 3-59 months. METHODS AND FINDINGS: We used a cluster-randomized, controlled design with nine control and nine intervention sublocations, equally distributed across three districts in western Kenya. Cross-sectional household surveys were conducted before and after the delivery of the intervention. The intervention comprised provision of subsidized packs of paediatric ACT to retail outlets, training of retail outlet staff, and community awareness activities. The primary outcome was defined as the proportion of children aged 3-59 months reporting fever in the past 2 weeks who started treatment with AL on the same day or following day of fever onset. Data were collected using structured questionnaires and analyzed based on cluster-level summaries, comparing control to intervention arms, while adjusting for other covariates. Data were collected on 2,749 children in the target age group at baseline and 2,662 at follow-up. 29% of children experienced fever within 2 weeks before the interview. At follow-up, the percentage of children receiving AL on the day of fever or the following day had risen by 14.6% points in the control arm (from 5.3% [standard deviation (SD): 3.2%] to 19.9% [SD: 10.0%]) and 40.2% points in the intervention arm (from 4.7% [SD: 3.4%] to 44.9% [SD: 11.7%]). The percentage of children receiving AL was significantly greater in the intervention arm at follow-up, with a difference between the arms of 25.0% points (95% confidence interval [CI]: 14.1%, 35.9%; unadjusted p = 0.0002, adjusted p = 0.0001). No significant differences were observed between arms in the proportion of caregivers who sought treatment for their child's fever by source, or in the child's adherence to AL. CONCLUSIONS: Subsidizing ACT in the retail sector can significantly increase ACT coverage for reported fevers in rural areas. Further research is needed on the impact and cost-effectiveness of such subsidy programmes at a national scale. TRIAL REGISTRATION: Current Controlled Trials ISRCTN59275137 and Kenya Pharmacy and Poisons Board Ethical Committee for Clinical Trials PPB/ECCT/08/07

Kangwana, BP

Kedenge, SV

Noor, AM

Alegana, VA

Nyandigisi, AJ

Pandit, J

Fegan, GW

Todd, JE

Brooker, S

Snow, Robert

Goodman, CA

ORA - Oxford University Research Archive

It has been proposed that artemisinin-based combination therapy (ACT) be subsidised in the private sector in order to improve affordability and access. This study in western Kenya aimed to evaluate the impact of providing subsidized artemether–lumefantrine (AL) through retail providers on the coverage of prompt, effective antimalarial treatment for febrile children aged 3–59 months. = 0.0001). No significant differences were observed between arms in the proportion of caregivers who sought treatment for their child's fever by source, or in the child's adherence to AL.Subsidizing ACT in the retail sector can significantly increase ACT coverage for reported fevers in rural areas. Further research is needed on the impact and cost-effectiveness of such subsidy programmes at a national scale. and Kenya Pharmacy and Poisons Board Ethical Committee for Clinical Trials PPB/ECCT/08/07.Please see later in the article for the Editors' Summar

Kangwana Beth P.

Kedenge Sarah V.

Noor Abdisalan M.

Alegana Victor A.

Nyandigisi Andrew J.

Pandit Jayesh

Fegan Greg W.

Todd James E.

Brooker Simon

Snow Robert W.

Goodman Catherine A.

Public Library of Science (PLOS)

The Impact of Retail-Sector Delivery of Artemether–Lumefantrine on Malaria Treatment of Children under Five in Kenya: A Cluster Randomized Controlled Trial

Crossref

Kangwana, Beth P

Kedenge, Sarah V

Noor, Abdisalan M

Alegana, Victor A

Nyandigisi, Andrew J

Pandit, Jayesh

Fegan, Greg W

Todd, James E

Brooker, Simon

Snow, Robert W

Goodman, Catherine A

LSHTM Research Online

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Greg Fegan

Cronfa at Swansea University

Kangwana, B

Kedenge, S

Alegana, V

Noor, A

Fegan, G

Todd, J

Snow, R

Goodman, C

Nyandigisi, A

The impact of retail-sector delivery of artemether-lumefantrine on malaria treatment of children under five in Kenya: cluster randomized controlled trial

The Impact of Retail-Sector Delivery of Artemether–Lumefantrine on Malaria Treatment of Children under Five in Kenya: A Cluster Randomized Controlled Trial

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