The malaria testing and treatment landscape in Kenya: Results from a nationally representative survey among the public and private sector in 2016

Louis Akulayi; Angela Alum; Andrew Andrada; Julie Archer; Ekundayo D. Arogundade; Erick Auko; Abdul R. Badru; Katie Bates; Paul Bouanchaud; Meghan Bruce; Katia Bruxvoort; Peter Buyungo; Angela Camilleri; Emily D. Carter; Steven Chapman; Nikki Charman; Desmond Chavasse; Robyn Cyr; Kevin Duff; Gylsain Guedegbe; Keith Esch; Illah Evance; Anna Fulton; Hellen Gataaka; Tarryn Haslam; Emily Harris; Christine Hong; Catharine Hurley; Whitney Isenhower; Enid Kaabunga; Baraka D. Kaaya; Esther Kabui; Beth Kangwana; Lason Kapata; Henry Kaula; Gloria Kigo; Irene Kyomuhangi; Aliza Lailari; Sandra Lefevre; Megan Littrell; Greta Martin; Daniel Michael; Erik Monroe; Godefroid Mpanya; Felton Mpasela; Felix Mulama; Julius Ngigi; Edward Ngoma; Marjorie Norman; Bernard Nyauchi; Kathryn A. O'Connell; Carolyne Ochieng; Edna Ogada; Linda Ongwenyi; Ricki Orford; Saysana Phanalasy; Stephen Poyer; Justin Rahariniaina; Jacky Raharinjatovo; Lanto Razafindralambo; Solofo Razakamiadana; Christina Riley; John Rodgers; Andria Rusk; Tanya Shewchuk; Simon Sensalire; Julianna Smith; Phok Sochea; Tsione Solomon; Raymond Sudoi; Martine Esther Tassiba; Katherine Thanel; Rachel Thompson; Mitsuru Toda; Chinazo Ujuju; Marie Alix Valensi; Vamsi Vasireddy; Cynthia B. Whitman; Cyprien Zinsou; Anne Musuva; Waqo Ejersa; Rebecca Kiptui; Dorothy Memusi; Edward Abwao

doi:10.1186/s12936-017-2089-0

The malaria testing and treatment landscape in Kenya: Results from a nationally representative survey among the public and private sector in 2016

Louis Akulayi, Angela Alum, Andrew Andrada, Julie Archer, Ekundayo D. Arogundade, Erick Auko, Abdul R. Badru, Katie Bates, Paul Bouanchaud, Meghan Bruce, Katia Bruxvoort, Peter Buyungo, Angela Camilleri, Emily D. Carter, Steven Chapman, Nikki Charman, Desmond Chavasse, Robyn Cyr, Kevin Duff, Gylsain GuedegbeKeith Esch, Illah Evance, Anna Fulton, Hellen Gataaka, Tarryn Haslam, Emily Harris, Christine Hong, Catharine Hurley, Whitney Isenhower, Enid Kaabunga, Baraka D. Kaaya, Esther Kabui, Beth Kangwana, Lason Kapata, Henry Kaula, Gloria Kigo, Irene Kyomuhangi, Aliza Lailari, Sandra Lefevre, Megan Littrell, Greta Martin, Daniel Michael, Erik Monroe, Godefroid Mpanya, Felton Mpasela, Felix Mulama, Julius Ngigi, Edward Ngoma, Marjorie Norman, Bernard Nyauchi, Kathryn A. O'Connell, Carolyne Ochieng, Edna Ogada, Linda Ongwenyi, Ricki Orford, Saysana Phanalasy, Stephen Poyer, Justin Rahariniaina, Jacky Raharinjatovo, Lanto Razafindralambo, Solofo Razakamiadana, Christina Riley, John Rodgers, Andria Rusk, Tanya Shewchuk, Simon Sensalire, Julianna Smith, Phok Sochea, Tsione Solomon, Raymond Sudoi, Martine Esther Tassiba, Katherine Thanel, Rachel Thompson, Mitsuru Toda, Chinazo Ujuju, Marie Alix Valensi, Vamsi Vasireddy, Cynthia B. Whitman, Cyprien Zinsou, Anne Musuva, Waqo Ejersa, Rebecca Kiptui, Dorothy Memusi, Edward Abwao

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Since 2004, Kenya's national malaria treatment guidelines have stipulated artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria, and since 2014, confirmatory diagnosis of malaria in all cases before treatment has been recommended. A number of strategies to support national guidelines have been implemented in the public and private sectors in recent years. A nationally-representative malaria outlet survey, implemented across four epidemiological zones, was conducted between June and August 2016 to provide practical evidence to inform strategies and policies in Kenya towards achieving national malaria control goals. Results: A total of 17,852 outlets were screened and 2271 outlets were eligible and interviewed. 78.3% of all screened public health facilities stocked both malaria diagnostic testing and quality-assured ACT (QAACT). Sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy was available in 70% of public health facilities in endemic areas where it is recommended for treatment. SP was rarely found in the public sector outside of the endemic areas (< 0.5%). The anti-malaria stocking private sector had lower levels of QAACT (46.7%) and malaria blood testing (20.8%) availability but accounted for majority of anti-malarial distribution (70.6% of the national market share). More than 40% of anti-malarials were distributed by unregistered pharmacies (37.3%) and general retailers (7.1%). QAACT accounted for 58.2% of the total anti-malarial market share, while market share for non-QAACT was 15.8% and for SP, 24.8%. In endemic areas, 74.9% of anti-malarials distributed were QAACT. Elsewhere, QAACT market share was 49.4% in the endemic-prone areas, 33.2% in seasonal-transmission areas and 37.9% in low-risk areas. Conclusion: Although public sector availability of QAACT and malaria diagnosis is relatively high, there is a gap in availability of both testing and treatment that must be addressed. The private sector in Kenya, where the majority of anti-malarials are distributed, is also critical for achieving universal coverage with appropriate malaria case management. There is need for a renewed commitment and effective strategies to ensure access to affordable QAACT and confirmatory testing in the private sector, and should consider how to address malaria case management among informal providers responsible for a substantial proportion of the anti-malarial market share.

Original language	English (US)
Article number	494
Journal	Malaria journal
Volume	16
Issue number	1
DOIs	https://doi.org/10.1186/s12936-017-2089-0
State	Published - Dec 21 2017
Externally published	Yes

Keywords

ACT
Anti-malarial
Kenya
Malaria control case management
Malaria diagnosis
Private sector
Public sector

ASJC Scopus subject areas

Parasitology
Infectious Diseases

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10.1186/s12936-017-2089-0

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Akulayi, L., Alum, A., Andrada, A., Archer, J., Arogundade, E. D., Auko, E., Badru, A. R., Bates, K., Bouanchaud, P., Bruce, M., Bruxvoort, K., Buyungo, P., Camilleri, A., Carter, E. D., Chapman, S., Charman, N., Chavasse, D., Cyr, R., Duff, K., ... Abwao, E. (2017). The malaria testing and treatment landscape in Kenya: Results from a nationally representative survey among the public and private sector in 2016. Malaria journal, 16(1), [494]. https://doi.org/10.1186/s12936-017-2089-0

Akulayi, L, Alum, A, Andrada, A, Archer, J, Arogundade, ED, Auko, E, Badru, AR, Bates, K, Bouanchaud, P, Bruce, M, Bruxvoort, K, Buyungo, P, Camilleri, A, Carter, ED, Chapman, S, Charman, N, Chavasse, D, Cyr, R, Duff, K, Guedegbe, G, Esch, K, Evance, I, Fulton, A, Gataaka, H, Haslam, T, Harris, E, Hong, C, Hurley, C, Isenhower, W, Kaabunga, E, Kaaya, BD, Kabui, E, Kangwana, B, Kapata, L, Kaula, H, Kigo, G, Kyomuhangi, I, Lailari, A, Lefevre, S, Littrell, M, Martin, G, Michael, D, Monroe, E, Mpanya, G, Mpasela, F, Mulama, F, Ngigi, J, Ngoma, E, Norman, M, Nyauchi, B, O'Connell, KA, Ochieng, C, Ogada, E, Ongwenyi, L, Orford, R, Phanalasy, S, Poyer, S, Rahariniaina, J, Raharinjatovo, J, Razafindralambo, L, Razakamiadana, S, Riley, C, Rodgers, J, Rusk, A, Shewchuk, T, Sensalire, S, Smith, J, Sochea, P, Solomon, T, Sudoi, R, Tassiba, ME, Thanel, K, Thompson, R, Toda, M, Ujuju, C, Valensi, MA, Vasireddy, V, Whitman, CB, Zinsou, C, Musuva, A, Ejersa, W, Kiptui, R, Memusi, D & Abwao, E 2017, 'The malaria testing and treatment landscape in Kenya: Results from a nationally representative survey among the public and private sector in 2016', Malaria journal, vol. 16, no. 1, 494. https://doi.org/10.1186/s12936-017-2089-0

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title = "The malaria testing and treatment landscape in Kenya: Results from a nationally representative survey among the public and private sector in 2016",

abstract = "Background: Since 2004, Kenya's national malaria treatment guidelines have stipulated artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria, and since 2014, confirmatory diagnosis of malaria in all cases before treatment has been recommended. A number of strategies to support national guidelines have been implemented in the public and private sectors in recent years. A nationally-representative malaria outlet survey, implemented across four epidemiological zones, was conducted between June and August 2016 to provide practical evidence to inform strategies and policies in Kenya towards achieving national malaria control goals. Results: A total of 17,852 outlets were screened and 2271 outlets were eligible and interviewed. 78.3% of all screened public health facilities stocked both malaria diagnostic testing and quality-assured ACT (QAACT). Sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy was available in 70% of public health facilities in endemic areas where it is recommended for treatment. SP was rarely found in the public sector outside of the endemic areas (< 0.5%). The anti-malaria stocking private sector had lower levels of QAACT (46.7%) and malaria blood testing (20.8%) availability but accounted for majority of anti-malarial distribution (70.6% of the national market share). More than 40% of anti-malarials were distributed by unregistered pharmacies (37.3%) and general retailers (7.1%). QAACT accounted for 58.2% of the total anti-malarial market share, while market share for non-QAACT was 15.8% and for SP, 24.8%. In endemic areas, 74.9% of anti-malarials distributed were QAACT. Elsewhere, QAACT market share was 49.4% in the endemic-prone areas, 33.2% in seasonal-transmission areas and 37.9% in low-risk areas. Conclusion: Although public sector availability of QAACT and malaria diagnosis is relatively high, there is a gap in availability of both testing and treatment that must be addressed. The private sector in Kenya, where the majority of anti-malarials are distributed, is also critical for achieving universal coverage with appropriate malaria case management. There is need for a renewed commitment and effective strategies to ensure access to affordable QAACT and confirmatory testing in the private sector, and should consider how to address malaria case management among informal providers responsible for a substantial proportion of the anti-malarial market share.",

keywords = "ACT, Anti-malarial, Kenya, Malaria control case management, Malaria diagnosis, Private sector, Public sector",

author = "Louis Akulayi and Angela Alum and Andrew Andrada and Julie Archer and Arogundade, {Ekundayo D.} and Erick Auko and Badru, {Abdul R.} and Katie Bates and Paul Bouanchaud and Meghan Bruce and Katia Bruxvoort and Peter Buyungo and Angela Camilleri and Carter, {Emily D.} and Steven Chapman and Nikki Charman and Desmond Chavasse and Robyn Cyr and Kevin Duff and Gylsain Guedegbe and Keith Esch and Illah Evance and Anna Fulton and Hellen Gataaka and Tarryn Haslam and Emily Harris and Christine Hong and Catharine Hurley and Whitney Isenhower and Enid Kaabunga and Kaaya, {Baraka D.} and Esther Kabui and Beth Kangwana and Lason Kapata and Henry Kaula and Gloria Kigo and Irene Kyomuhangi and Aliza Lailari and Sandra Lefevre and Megan Littrell and Greta Martin and Daniel Michael and Erik Monroe and Godefroid Mpanya and Felton Mpasela and Felix Mulama and Julius Ngigi and Edward Ngoma and Marjorie Norman and Bernard Nyauchi and O'Connell, {Kathryn A.} and Carolyne Ochieng and Edna Ogada and Linda Ongwenyi and Ricki Orford and Saysana Phanalasy and Stephen Poyer and Justin Rahariniaina and Jacky Raharinjatovo and Lanto Razafindralambo and Solofo Razakamiadana and Christina Riley and John Rodgers and Andria Rusk and Tanya Shewchuk and Simon Sensalire and Julianna Smith and Phok Sochea and Tsione Solomon and Raymond Sudoi and Tassiba, {Martine Esther} and Katherine Thanel and Rachel Thompson and Mitsuru Toda and Chinazo Ujuju and Valensi, {Marie Alix} and Vamsi Vasireddy and Whitman, {Cynthia B.} and Cyprien Zinsou and Anne Musuva and Waqo Ejersa and Rebecca Kiptui and Dorothy Memusi and Edward Abwao",

note = "Funding Information: The Kenya 2016 ACTwatch outlet survey and the production of this manuscripts received financial support from UNITAID and the Bill and Melinda Gates Foundation. Publisher Copyright: {\textcopyright} 2017 The Author(s).",

year = "2017",

month = dec,

day = "21",

doi = "10.1186/s12936-017-2089-0",

language = "English (US)",

volume = "16",

journal = "Malaria Journal",

issn = "1475-2875",

publisher = "BioMed Central",

number = "1",

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TY - JOUR

T1 - The malaria testing and treatment landscape in Kenya

T2 - Results from a nationally representative survey among the public and private sector in 2016

AU - Akulayi, Louis

AU - Alum, Angela

AU - Andrada, Andrew

AU - Archer, Julie

AU - Arogundade, Ekundayo D.

AU - Auko, Erick

AU - Badru, Abdul R.

AU - Bates, Katie

AU - Bouanchaud, Paul

AU - Bruce, Meghan

AU - Bruxvoort, Katia

AU - Buyungo, Peter

AU - Camilleri, Angela

AU - Carter, Emily D.

AU - Chapman, Steven

AU - Charman, Nikki

AU - Chavasse, Desmond

AU - Cyr, Robyn

AU - Duff, Kevin

AU - Guedegbe, Gylsain

AU - Esch, Keith

AU - Evance, Illah

AU - Fulton, Anna

AU - Gataaka, Hellen

AU - Haslam, Tarryn

AU - Harris, Emily

AU - Hong, Christine

AU - Hurley, Catharine

AU - Isenhower, Whitney

AU - Kaabunga, Enid

AU - Kaaya, Baraka D.

AU - Kabui, Esther

AU - Kangwana, Beth

AU - Kapata, Lason

AU - Kaula, Henry

AU - Kigo, Gloria

AU - Kyomuhangi, Irene

AU - Lailari, Aliza

AU - Lefevre, Sandra

AU - Littrell, Megan

AU - Martin, Greta

AU - Michael, Daniel

AU - Monroe, Erik

AU - Mpanya, Godefroid

AU - Mpasela, Felton

AU - Mulama, Felix

AU - Ngigi, Julius

AU - Ngoma, Edward

AU - Norman, Marjorie

AU - Nyauchi, Bernard

AU - O'Connell, Kathryn A.

AU - Ochieng, Carolyne

AU - Ogada, Edna

AU - Ongwenyi, Linda

AU - Orford, Ricki

AU - Phanalasy, Saysana

AU - Poyer, Stephen

AU - Rahariniaina, Justin

AU - Raharinjatovo, Jacky

AU - Razafindralambo, Lanto

AU - Razakamiadana, Solofo

AU - Riley, Christina

AU - Rodgers, John

AU - Rusk, Andria

AU - Shewchuk, Tanya

AU - Sensalire, Simon

AU - Smith, Julianna

AU - Sochea, Phok

AU - Solomon, Tsione

AU - Sudoi, Raymond

AU - Tassiba, Martine Esther

AU - Thanel, Katherine

AU - Thompson, Rachel

AU - Toda, Mitsuru

AU - Ujuju, Chinazo

AU - Valensi, Marie Alix

AU - Vasireddy, Vamsi

AU - Whitman, Cynthia B.

AU - Zinsou, Cyprien

AU - Musuva, Anne

AU - Ejersa, Waqo

AU - Kiptui, Rebecca

AU - Memusi, Dorothy

AU - Abwao, Edward

N1 - Funding Information: The Kenya 2016 ACTwatch outlet survey and the production of this manuscripts received financial support from UNITAID and the Bill and Melinda Gates Foundation. Publisher Copyright: © 2017 The Author(s).

PY - 2017/12/21

Y1 - 2017/12/21

N2 - Background: Since 2004, Kenya's national malaria treatment guidelines have stipulated artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria, and since 2014, confirmatory diagnosis of malaria in all cases before treatment has been recommended. A number of strategies to support national guidelines have been implemented in the public and private sectors in recent years. A nationally-representative malaria outlet survey, implemented across four epidemiological zones, was conducted between June and August 2016 to provide practical evidence to inform strategies and policies in Kenya towards achieving national malaria control goals. Results: A total of 17,852 outlets were screened and 2271 outlets were eligible and interviewed. 78.3% of all screened public health facilities stocked both malaria diagnostic testing and quality-assured ACT (QAACT). Sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy was available in 70% of public health facilities in endemic areas where it is recommended for treatment. SP was rarely found in the public sector outside of the endemic areas (< 0.5%). The anti-malaria stocking private sector had lower levels of QAACT (46.7%) and malaria blood testing (20.8%) availability but accounted for majority of anti-malarial distribution (70.6% of the national market share). More than 40% of anti-malarials were distributed by unregistered pharmacies (37.3%) and general retailers (7.1%). QAACT accounted for 58.2% of the total anti-malarial market share, while market share for non-QAACT was 15.8% and for SP, 24.8%. In endemic areas, 74.9% of anti-malarials distributed were QAACT. Elsewhere, QAACT market share was 49.4% in the endemic-prone areas, 33.2% in seasonal-transmission areas and 37.9% in low-risk areas. Conclusion: Although public sector availability of QAACT and malaria diagnosis is relatively high, there is a gap in availability of both testing and treatment that must be addressed. The private sector in Kenya, where the majority of anti-malarials are distributed, is also critical for achieving universal coverage with appropriate malaria case management. There is need for a renewed commitment and effective strategies to ensure access to affordable QAACT and confirmatory testing in the private sector, and should consider how to address malaria case management among informal providers responsible for a substantial proportion of the anti-malarial market share.

AB - Background: Since 2004, Kenya's national malaria treatment guidelines have stipulated artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria, and since 2014, confirmatory diagnosis of malaria in all cases before treatment has been recommended. A number of strategies to support national guidelines have been implemented in the public and private sectors in recent years. A nationally-representative malaria outlet survey, implemented across four epidemiological zones, was conducted between June and August 2016 to provide practical evidence to inform strategies and policies in Kenya towards achieving national malaria control goals. Results: A total of 17,852 outlets were screened and 2271 outlets were eligible and interviewed. 78.3% of all screened public health facilities stocked both malaria diagnostic testing and quality-assured ACT (QAACT). Sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy was available in 70% of public health facilities in endemic areas where it is recommended for treatment. SP was rarely found in the public sector outside of the endemic areas (< 0.5%). The anti-malaria stocking private sector had lower levels of QAACT (46.7%) and malaria blood testing (20.8%) availability but accounted for majority of anti-malarial distribution (70.6% of the national market share). More than 40% of anti-malarials were distributed by unregistered pharmacies (37.3%) and general retailers (7.1%). QAACT accounted for 58.2% of the total anti-malarial market share, while market share for non-QAACT was 15.8% and for SP, 24.8%. In endemic areas, 74.9% of anti-malarials distributed were QAACT. Elsewhere, QAACT market share was 49.4% in the endemic-prone areas, 33.2% in seasonal-transmission areas and 37.9% in low-risk areas. Conclusion: Although public sector availability of QAACT and malaria diagnosis is relatively high, there is a gap in availability of both testing and treatment that must be addressed. The private sector in Kenya, where the majority of anti-malarials are distributed, is also critical for achieving universal coverage with appropriate malaria case management. There is need for a renewed commitment and effective strategies to ensure access to affordable QAACT and confirmatory testing in the private sector, and should consider how to address malaria case management among informal providers responsible for a substantial proportion of the anti-malarial market share.

KW - ACT

KW - Anti-malarial

KW - Kenya

KW - Malaria control case management

KW - Malaria diagnosis

KW - Private sector

KW - Public sector

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UR - http://www.scopus.com/inward/citedby.url?scp=85039072126&partnerID=8YFLogxK

U2 - 10.1186/s12936-017-2089-0

DO - 10.1186/s12936-017-2089-0

M3 - Article

C2 - 29268789

AN - SCOPUS:85039072126

SN - 1475-2875

VL - 16

JO - Malaria Journal

JF - Malaria Journal

IS - 1

M1 - 494

ER -

The malaria testing and treatment landscape in Kenya: Results from a nationally representative survey among the public and private sector in 2016

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