title: Geographically-weighted regression of knowledge and behaviour determinants to anti-malarial recommending and dispensing practice among medicine retailers in western Kenya: capacitating targeted interventions.
abstract: BACKGROUND
  Most patients with malaria seek treatment first in retail drug shops. Myriad studies have examined retailer behaviours and characteristics to understand the determinants to these behaviours. Geospatial methods are helpful in discovering if geographic location plays a role in the relationship between determinants and outcomes. This study aimed to discover if spatial autocorrelation exists in the relationship between determinants and retailer behaviours, and to provide specific geographic locations and target behaviours for tailoring future interventions.
  
  
  METHODS
  Retailer behaviours and characteristics captured from a survey deployed to medicine retailers in the Webuye Demographic and Health Surveillance Site were analysed using geographic weighted regression to create prediction models for three separate outcomes: recommending the first-line anti-malarial therapy to adults, recommending the first-line anti-malarial therapy to children, and selling that therapy more than other anti-malarials. The estimated regression coefficients for each determinant, as well as the pseudo R2values for each final model, were then mapped to assess spatial variability and local areas of best model fit.
  
  
  RESULTS
  The relationships explored were found to be non-stationary, indicating that spatial heterogeneity exist in the data. The association between having a pharmacy-related health training and recommending the first-line anti-malarial treatment to adults was strongest around the peri-urban centre: comparing those with training in pharmacy to those without training (OR = 5.75, p = 0.021). The association between knowing the first-line anti-malarial and recommending it to children was strongest in the north of the study area compared to those who did not know the MOH-recommended anti-malarial (OR = 2.34, p = 0.070). This is also the area with the strongest association between attending a malaria workshop and selling the MOH-recommended anti-malarial more than other anti-malarials, compared to retailers who did not attend a workshop (OR = 2.38, p = 0.055).
  
  
  CONCLUSIONS
  Evidence suggests that spatial heterogeneity exists in these data, indicating that the relationship between determinants and behaviours varies across space. This is valuable information for intervention design, allowing efforts to focus on those factors that have the strongest relationship with their targeted behaviour within that geographic space, increasing programme efficiency and cost-effectiveness.
authors.affiliation: Dominican University of California, San Rafael, CA, USA. Andria.Rusk@Dominican.edu.|The University of Texas School of Public Health, Pressler Dr, Houston, TX, USA. Andria.Rusk@Dominican.edu.
authors.forename: Andria
authors.identifier: http://orcid.org/0000-0003-3485-084X
authors.initials: A
authors.lastname: Rusk
authors.affiliation: The University of Texas School of Public Health, Pressler Dr, Houston, TX, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Highfield
authors.affiliation: The University of Texas School of Public Health, Pressler Dr, Houston, TX, USA.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Wilkerson
authors.affiliation: The University of Texas School of Public Health, Pressler Dr, Houston, TX, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Harrell
authors.affiliation: Moi University School of Medicine, Nandi Rd, Eldoret, Kenya.|Webuye Demographic Surveillance Site Scientific Steering Committee, Eldoret, Kenya.
authors.forename: Andrew
authors.initials: A
authors.lastname: Obala
authors.affiliation: Department of Health Policy and Management, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA.|Institute for Work & Health, Toronto, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Amick
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D010594:Pharmacies; D000068916:Spatial Regression; D011795:Surveys and Questionnaires
chemical_list: D000962:Antimalarials
keywords: Antimalarial drugs; Behavior; Geographically weighted regression; Malaria; Private sector