title: The association between price, competition, and demand factors on private sector anti-malarial stocking and sales in western Kenya: considerations for the AMFm subsidy.
abstract: BACKGROUND
  Households in sub-Saharan Africa are highly reliant on the retail sector for obtaining treatment for malaria fevers and other illnesses. As donors and governments seek to promote the use of artemisinin combination therapy in malaria-endemic areas through subsidized anti-malarials offered in the retail sector, understanding the stocking and pricing decisions of retail outlets is vital.
  
  
  METHODS
  A survey of all medicine retailers serving Bungoma East District in western Kenya was conducted three months after the launch of the AMFm subsidy in Kenya. The survey obtained information on each anti-malarial in stock: brand name, price, sales volume, outlet characteristics and GPS co-ordinates. These data were matched to household-level data from the Webuye Health and Demographic Surveillance System, from which population density and fever prevalence near each shop were determined. Regression analysis was used to identify the factors associated with retailers' likelihood of stocking subsidized artemether lumefantrine (AL) and the association between price and sales for AL, quinine and sulphadoxine-pyrimethamine (SP).
  
  
  RESULTS
  Ninety-seven retail outlets in the study area were surveyed; 11% of outlets stocked subsidized AL. Size of the outlet and having a pharmacist on staff were associated with greater likelihood of stocking subsidized AL. In the multivariable model, total volume of anti-malarial sales was associated with greater likelihood of stocking subsidized AL and competition was important; likelihood of stocking subsidized AL was considerably higher if the nearest neighbour stocked subsidized AL. Price was a significant predictor of sales volume for all three types of anti-malarials but the relationship varied, with the largest price sensitivity found for SP drugs.
  
  
  CONCLUSIONS
  The results suggest that helping small outlets overcome the constraints to stocking subsidized AL should be a priority. Competition between retailers and prices can play an important role in greater adoption of AL.
authors.affiliation: Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA. wpo@duke.edu
authors.forename: Wendy Prudhomme
authors.initials: WP
authors.lastname: O'Meara
authors.forename: Andrew
authors.initials: A
authors.lastname: Obala
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.forename: Barasa
authors.initials: B
authors.lastname: Khwa-Otsyula
mesh_terms: D000962:Antimalarials / Q000191:economics* / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000191:economics / Q000627:therapeutic use; D003132:Commerce; D004338:Drug Combinations; D004356:Drug Storage / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004983:Ethanolamines / Q000191:economics / Q000627:therapeutic use; D005380:Financing, Government / Q000458:organization & administration; D005449:Fluorenes / Q000191:economics / Q000627:therapeutic use; D007630:Kenya; D008288:Malaria / Q000188:drug therapy*; D017149:Private Sector; D011739:Pyrimethamine / Q000191:economics / Q000627:therapeutic use; D011803:Quinine / Q000191:economics / Q000627:therapeutic use; D013413:Sulfadoxine / Q000191:economics / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011803:Quinine; D011739:Pyrimethamine