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




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Reference: Kangwana, BP, Kedenge, SV, Noor, AM et al., (2011). The impact of retail-sector delivery of artemether-lumefantrine on malaria treatment of children under five in Kenya: a cluster randomized controlled trial. PLoS medicine, 8 (5), Article: e1000437.Citable link to this page:

 

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

Abstract: 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.

Peer Review status:Peer reviewedPublication status:PublishedVersion:Publisher's version Funder: Department for International Development   Funder: United States Agency for International Development   Funder: Wellcome Trust   Funder: Kenya Medical Research Institute   Notes:© 2011 Kangwana et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Bibliographic Details

Publisher: Public Library of Science

Publisher Website: http://www.plos.org/

Journal: PLoS medicinesee more from them

Publication Website: http://www.plosmedicine.org/

Issue Date: 2011-5

pages:Article: e1000437Identifiers

Urn: uuid:8d4388fd-a033-4648-b4b0-4e94c6b791eb

Source identifier: 151224

Eissn: 1549-1676

Doi: https://doi.org/10.1371/journal.pmed.1000437

Issn: 1549-1277 Item Description

Type: Journal article;

Language: eng

Version: Publisher's versionKeywords: Humans Plasmodium falciparum Malaria, Falciparum Ethanolamines Drug Combinations Treatment Outcome Rural Health Services Cost-Benefit Analysis Rural Population Artemisinins Child, Preschool Infant Antimalarials Private Sector Cross-Sectional Studies Health Services Accessibility Kenya Female Fluorenes Male Tiny URL: pubs:151224

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Autor: Kangwana, BP - - - Kedenge, SV - - - Noor, AM - institutionUniversity of Oxford grantNumber#081829 fundingWellcome Trust - - - Al

Fuente: https://ora.ox.ac.uk/objects/uuid:8d4388fd-a033-4648-b4b0-4e94c6b791eb



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