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Impact of Ministry of Health Interventions on Private Medicine Retailer Knowledge and Practices on Anti-Malarial Treatment in Kenya

Small-scale interventions on training medicine retailers on malaria treatment improve over-the-counter medicine use, but there is little evidence on effectiveness when scaled up. This study evaluated the impact of Ministry of Health (MoH) training programs on the knowledge and practices of medicine retailers in three districts in Kenya. A cluster randomized trial was planned across 10 administrative divisions. Findings indicated that 30.7% (95% confidence interval [CI]: 23.3, 39.0) and 5.2% (95% CI: 2.1, 10.3) of program and control retailers, respectively, sold MoH amodiaquine with correct advice on use to surrogate clients (OR = 8.8; 95% CI: 2.9, 26.9; P < 0.001). Similarly, 61.8% (95% CI: 54.2, 69.1) and 6.3% (95% CI: 2.7, 12.1) of program and control retailers, respectively, reported correct knowledge on dosing with amodiaquine (OR = 29.8; 95% CI: 8.2, 108.8). Large-scale retailer training programs within the national malaria control framework led to significant improvements in retailers’ practices across three districts.

Received November 17, 2008. Accepted for publication February 5, 2009.

Acknowledgments: We are grateful to all study subjects, the support and contributions of the District Health Management Teams, administrative leaders, field workers, and community members in Busia, Kwale, and Makueni districts. We also thank Richard Rimba and Francis Kombe for providing logistical support during data collection and Bob Snow, Catherine Goodman, and Kara Hanson for comments on earlier versions of the manuscript.

Financial support: This study was supported by WHO/TDR, CDC, the Kenya Medical Research Institute (KEMRI), and the Wellcome Trust. This paper is published with the permission of the Director of KEMRI.

^* Address correspondence to Timothy Abuya, Kenya Medical Research Institute/Wellcome Trust Centre for Geographic Medicine Research-Coast, 80108, PO Box 230, Kilifi, Kenya. E-mail: Tabuya{at}kilifi.kemri-wellcome.org

Authors’ addresses: Timothy Abuya, Kenya Medical Research Institute / Wellcome Trust Centre for Geographic Medicine Research-Coast, 80108, PO Box 230, Kilifi, Kenya, Tel: 254-41-7522063/254-41-7525044, Fax: 254-41-7522390, E-mail: Tabuya{at}kilifi.kemri-wellcome.org. Greg Fegan, Kenya Medical Research Institute/Wellcome Trust Centre for Geographic Medicine Research-Coast,80108, POBox230, Kilifi, Kenya, Tel: 254-41-7522063/254-41-7525044, Fax: 254-41-7522390, E-mail: gfegan{at}kilifi.kemri-wellcome.org and Infectious Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Yvone Rowa, Kenya Medical Research Institute/ Wellcome Trust Centre for Geographic Medicine Research-Coast, 80108, PO Box 230, Kilifi, Kenya, Tel: 254-41-7522063/254-41-7525044, Fax: 254-41-7522390, E-mail: Yverowa{at}yahoo.co.uk. Baya Karisa, Ministry of Health, Kilifi District Hospital, 80108, PO Box 9, Kilifi, Kenya, Tel: 254-41-522777, E-mail: ekbaya{at}yahoo.co.uk. Sam Ochola, Provincial Medical Officer, PO Box 34349-00100, Nairobi Province, Nairobi, Tel: 254-20-217129/20-313481, Fax: 254-20-217129, E-mail: Sochola06{at}yahoo.com. Wilfred Mutemi, World Vision Kenya, E-mail: wilfred_mutemi{at}wvi.org. Vicki Marsh, Kenya Medical Research Institute/Wellcome Trust Centre for Geographic Medicine Research-Coast, 80108, PO Box 230, Kilifi, Kenya, Tel: 254-41-7522063/254-41-7525044, Fax: 254-41-7522390, E-mail: vmarsh{at}kilifi.kemri-wellcome.org and Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Headington, Oxford OX3 9DU, UK.