The magnitude and trend of artemether-lumefantrine stock-outs at public health facilities in Kenya.
BACKGROUND
Health facility stock-outs of artemether-lumefantrine (AL), the common first-line therapy for uncomplicated malaria across Africa, adversely affect effective malaria case-management. They have been previously reported on various scales in time and space, however the magnitude of the problem and trends over time are less clear. Here, 2010-2011 data are reported from public facilities in Kenya where alarming stock-outs were revealed in 2008.


METHODS
Data were collected between January 2010 and June 2011 as part of 18 monthly cross-sectional surveys undertaken at nationally representative samples of public health facilities. The primary monitoring indicator was total stock-out of all four weight-specific AL packs. The secondary indicators were stock-outs of at least one AL pack and individual stock-outs for each AL pack. Monthly proportions and summary means of the proportions over the monitoring period were measured for each indicator. Stock-out trends were assessed using linear regression.


RESULTS
The number of surveyed facilities across 18 time points ranged between 162 and 176 facilities. The stock-out means of the proportion of health facilities were 11.6% for total AL stock-out, 40.6% for stock-out of at least one AL pack, and between 20.5% and 27.4% for stock-outs of individual AL packs. Monthly decrease of the total AL stock-out was 0.005% (95% CI: -0.5 to +0.5; p = 0.983). Monthly decrease in the stock-out of at least one AL pack was 0.7% (95% CI: -1.5 to +0.3; p = 0.058) while stock-outs of individual AL packs decreased monthly between 0.2% for AL 24-pack and 0.7% for AL six-pack without statistical significance for any of the weight-specific packs.


CONCLUSIONS
Despite lower levels of AL stock-outs compared to the reports in 2008, the stock-outs at Kenyan facilities during 2010-2011 are still substantial and of particular worry for the most detrimental:- simultaneous absence of any AL pack. Only minor decrease was observed in the stock-outs of individual AL packs. Recently launched interventions to eliminate AL stock-outs in Kenya are fully justified.
Malaria Public Health and Epidemiology Group, KEMRI/Wellcome Trust Research Programme, PO Box 43640, 00100 GPO Nairobi, Kenya.
Raymond K
RK
Sudoi
Sophie
S
Githinji
Andrew
A
Nyandigisi
Alex
A
Muturi
Robert W
RW
Snow
Dejan
D
Zurovac
D000962:Antimalarials / Q000600:supply & distribution* / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000600:supply & distribution* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D004983:Ethanolamines / Q000600:supply & distribution* / Q000627:therapeutic use; D005449:Fluorenes / Q000600:supply & distribution* / Q000627:therapeutic use; D006268:Health Facilities / Q000639:trends*; D006801:Humans; D007630:Kenya; D008288:Malaria / Q000188:drug therapy* / Q000469:parasitology; D010963:Plasmodium falciparum / Q000187:drug effects / Q000502:physiology
D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes