title: A cross-sectional study of the availability and price of anti-malarial medicines and malaria rapid diagnostic tests in private sector retail drug outlets in rural Western Kenya, 2013.
abstract: Although anti-malarial medicines are free in Kenyan public health facilities, patients often seek treatment from private sector retail drug outlets. In mid-2010, the Affordable Medicines Facility-malaria (AMFm) was introduced to make quality-assured artemisinin-based combination therapy (ACT) accessible and affordable in private and public sectors.
  
  
  
  Private sector retail drug outlets stocking anti-malarial medications within a surveillance area of approximately 220,000 people in a malaria perennial high-transmission area in rural western Kenya were identified via a census in September 2013. A cross-sectional study was conducted in September-October 2013 to determine availability and price of anti-malarial medicines and malaria rapid diagnostic tests (RDTs) in drug outlets. A standardized questionnaire was administered to collect drug outlet and personnel characteristics and availability and price of anti-malarials and RDTs.
  
  
  
  Of 181 drug outlets identified, 179 (99 %) participated in the survey. Thirteen percent were registered pharmacies, 25 % informal drug shops, 46 % general shops, 13 % homesteads and 2 % other. One hundred sixty-five (92 %) had at least one ACT type: 162 (91 %) had recommended first-line artemether-lumefantrine (AL), 22 (12 %) had recommended second-line dihydroartemisinin-piperaquine (DHA-PPQ), 85 (48 %) had sulfadoxine-pyrimethamine (SP), 60 (34 %) had any quinine (QN) formulation, and 14 (8 %) had amodiaquine (AQ) monotherapy. The mean price (range) of an adult treatment course for AL was $1.01 ($0.35-4.71); DHA-PPQ was $4.39 ($0.71-7.06); QN tablets were $2.24 ($0.12-4.71); SP was $0.62 ($0.24-2.35); AQ monotherapy was $0.42 ($0.24-1.06). The mean AL price with or without the AMFm logo did not differ significantly ($1.01 and 1.07, respectively; p = 0.45). Only 17 (10 %) drug outlets had RDTs; 149 (84 %) never stocked RDTs. The mean RDT price was $0.92 ($0.24-2.35).
  
  
  
  Most outlets never stocked RDTs; therefore, testing prior to treatment was unlikely for customers seeking treatment in the private retail sector. The recommended first-line treatment, AL, was widely available. Although SP and AQ monotherapy are not recommended for treatment, both were less expensive than AL, which might have caused preferential use by customers. Interventions that create community demand for malaria diagnostic testing prior to treatment and that increase RDT availability should be encouraged.
authors.affiliation: Malaria Control Unit, Ministry of Health, Afya House, Cathedral Road, PO Box 30016, Nairobi, 00100, Kenya.|Field Epidemiology and Laboratory Training Programme, Ministry of Health, Afya House, Cathedral Road, PO Box 30016, Nairobi, 00100, Kenya.
authors.forename: Urbanus
authors.initials: U
authors.lastname: Kioko
authors.affiliation: Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Riley
authors.affiliation: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, Merseyside, L3 5QA, UK.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dellicour
authors.affiliation: KEMRI, Centre for Global Health Research, Box 1578, Kisumu, 40100, Kenya.
authors.forename: Vincent
authors.initials: V
authors.lastname: Were
authors.affiliation: KEMRI, Centre for Global Health Research, Box 1578, Kisumu, 40100, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Ouma
authors.affiliation: Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, 1600 Clifton Rd NE, Mailstop A-06, Atlanta, GA, 30333, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Gutman
authors.affiliation: KEMRI, Centre for Global Health Research, Box 1578, Kisumu, 40100, Kenya.
authors.forename: Simon
authors.initials: S
authors.lastname: Kariuki
authors.affiliation: Malaria Control Unit, Ministry of Health, Afya House, Cathedral Road, PO Box 30016, Nairobi, 00100, Kenya.
authors.forename: Ahmeddin
authors.initials: A
authors.lastname: Omar
authors.affiliation: Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, 1600 Clifton Rd NE, Mailstop A-06, Atlanta, GA, 30333, USA.
authors.forename: Meghna
authors.initials: M
authors.lastname: Desai
authors.affiliation: Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, 1600 Clifton Rd NE, Mailstop A-06, Atlanta, GA, 30333, USA. ali3@cdc.gov.|U.S. President's Malaria Initiative, United Nations Avenue, Village Market, PO Box 606, Nairobi, 00621, Kenya. ali3@cdc.gov.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Buff
mesh_terms: D000962:Antimalarials / Q000191:economics* / Q000600:supply & distribution*; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000191:economics*; D006801:Humans; D007630:Kenya; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy*; D017149:Private Sector; D011933:Reagent Kits, Diagnostic / Q000191:economics* / Q000600:supply & distribution*; D012424:Rural Population; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D000962:Antimalarials; D011933:Reagent Kits, Diagnostic
keywords: Anti-malarials; Diagnostic tests; Kenya; Malaria; Private sector