Vendor-to-vendor education to improve malaria treatment by private drug outlets in Bungoma District, Kenya.
BACKGROUND
Private outlets are the main suppliers of uncomplicated malaria treatment in Africa. However, they are so numerous that they are difficult for governments to influence and regulate. This study's objective was to evaluate a low-cost outreach education (vendor-to-vendor) programme to improve the private sector's compliance with malaria guidelines in Bungoma district, Kenya. The cornerstone of the programme was the district's training of 73 wholesalers who were equipped with customized job aids for distribution to small retailers.


METHODS
Six months after training the wholesalers, the programme was evaluated using mystery shoppers. The shoppers posed as caretakers of sick children needing medication at 252 drug outlets. Afterwards, supervisors assessed the outlets' knowledge, drug stocks, and prices.


RESULTS
The intervention seems to have had a significant impact on stocking patterns, malaria knowledge and prescribing practices of shops/kiosks, but not consistently on other types of outlets. About 32% of shops receiving job aids prescribed to mystery shoppers the approved first-line drug, sulfadoxine-pyremethamine, as compared to only 3% of the control shops. In the first six months, it is estimated that 500 outlets were reached, at a cost of about $8000.


CONCLUSIONS
Changing private sector knowledge and practices is widely acknowledged to be slow and difficult. The vendor-to-vendor programme seems a feasible district-level strategy for achieving significant improvements in knowledge and practices of shops/kiosks. However, alternate strategies will be needed to influence pharmacies and clinics. Overall, the impact will be only moderate unless national policies and programmes are also introduced.
Tavrow
Paula
P
School of Public Health, University of California, Los Angeles, California, USA. ptavrow@ucla.edu
Shabahang
Jennifer
J
Makama
Sammy
S
D000328:Adult; D000655:Amodiaquine / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use; D000962:Antimalarials / Q000191:economics / Q000600:supply & distribution* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use; D003132:Commerce / Q000193:education* / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data; D004338:Drug Combinations; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006266:Health Education / Q000379:methods*; D006801:Humans; D007630:Kenya; D008288:Malaria / Q000188:drug therapy* / Q000191:economics; D008297:Male; D011739:Pyrimethamine / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use; D019035:Rural Health Services / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data / Q000600:supply & distribution; D013413:Sulfadoxine / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use; D019037:Urban Health Services / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data / Q000600:supply & distribution
D000962:Antimalarials; D004338:Drug Combinations; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine