Abstract:
Background: Malaria is a major cause of morbidity and mortality in Kenya, where it is the fifth leading cause of
death in both children and adults. Effectively managing malaria is dependent upon appropriate treatment. In Kenya,
between 17 to 83 percent of febrile individuals first seek treatment for febrile illness over the counter from
medicine retailers. Understanding medicine retailer knowledge and behaviour in treating suspected malaria and
dispensing anti-malarials is crucial.
Methods: To investigate medicine retailer knowledge about anti-malarials and their dispensing practices, a survey
was conducted of all retail drug outlets that sell anti-malarial medications and serve residents of the Webuye Health
and Demographic Surveillance Site in the Bungoma East District of western Kenya.
Results: Most of the medicine retailers surveyed (65%) were able to identify artemether-lumefantrine (AL) as the
Kenyan Ministry of Health recommended first-line anti-malarial therapy for uncomplicated malaria. Retailers who
correctly identified this treatment were also more likely to recommend AL to adult and paediatric customers.
However, the proportion of medicine retailers who recommend the correct treatment is disappointingly low.
Only 48% would recommend AL to adults, and 37% would recommend it to children. It was discovered that
customer demand has an influence on retailer behaviour. Retailer training and education were found to be
correlated with anti-malarial drug knowledge, which in turn is correlated with dispensing practices. Medicine retailer
behaviour, including patient referral practice and dispensing practices, are also correlated with knowledge of the
first-line anti-malarial medication. The Kenya Ministry of Health guidelines were found to influence retailer drug
stocking and dispensing behaviours.
Conclusion: Most medicine retailers could identify the recommended first-line treatment for uncomplicated
malaria, but the percentage that could not is still too high. Furthermore, knowing the MOH recommended
anti-malarial medication does not always ensure it is recommended or dispensed to customers. Retailer training
and education are both areas that could be improved. Considering the influence that patient demand has on
retailer behaviour, future interventions focusing on community education may positively influence appropriate
dispensing of anti-malarials.