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Roll-Back Malaria Conference Showcases the QA Project's Malaria Drug Study
Innovative Intervention Educates Kenyans on Correct Treatment

by Cynthia F. Young, Senior Staff Writer

The USAID-funded Quality Assurance Project presented the findings of its successful public/private partnership to educate private drug outlets on correct malaria treatment in rural Kenya at the Fourth Global Partners Meeting to Roll Back Malaria in Washington, DC, on April 18.



Paula Tavrow, PhD, of the QA Project and Sammy Makama, of Bungoma DHMT, with a job aid poster created to educate malaria drug clients about the correct malaria treatment.

This innovative, cost-effective "vendor-to-vendor" program entailed training wholesale drug vendors to communicate malaria guidelines to retail drug outlets. It may eventually be implemented on a national level.

In the Bungoma district of Kenya, malaria is the leading cause of mortality. The Bungoma District Health Management Team (DHMT), led by Mr. Sammy Makama, and Dr. Paula Tavrow, Ph.D. and Ms. Jennifer Shabahang, MHS of the QA Project, developed this intervention last year to increase compliance with the Kenyan Ministry of Health’s new malaria guidelines in the private sector. The program was sponsored by USAID’s Africa Integrated Malaria Initiative. Mr. Makama shared the program’s successful results at the Partners Meeting.

The private sector in developing countries is largely unregulated, and shopkeepers can be unaware of the Ministry’s new malaria guidelines. In 1998, the Ministry designated sulfadoxine-pyrimethamine (SP) drugs as the first-line anti-malarial medication.

Research has shown that the majority of Africans seek malaria treatment from the nearest private drug outlet, such as a small shop, pharmacy, or clinic. In the Bungoma district, these outlets sell a wide variety of malaria drugs, including unapproved or expired medicines and in unlabeled containers.

To address these problems, the research team developed a program using wholesale drug vendors to orient drug retailers on the new guidelines. Vendors were asked to distribute job aid posters to the outlets, which explained the approved SP drugs and correct dosages. More than 500 outlets were reached.



A team supervisor showing malaria drugs purchased by mystery drug shoppers at private drug outlets

The research team then evaluated the program using mystery shoppers who posed as customers. They purchased drugs while pretending to be a mother or father with a sick child.

The results showed a dramatic improvement in shopkeepers’ knowledge and compliance with malaria guidelines among outlets that received job aid posters. Significantly, mystery shoppers were nine times more likely to receive the recommended drugs from these outlets (18 versus 2 percent).

This intervention is also affordable. The estimated cost of replication in another district in Kenya is $8,300. An estimated 82,000 malaria clients were treated properly in the first six months due to this intervention. Researchers estimate the program’s cost was 10 cents per correctly treated individual.

Because of these promising findings, the team recommended that Kenya’s National Malaria Control Programme consider a roll-out of the intervention to all endemic malaria areas, advise pharmaceutical companies to indicate dosages for all age groups on packaging, ensure that unapproved anti-malarial drugs do not reach the market, and address misconceptions about malaria in health education. (posted April 19, 2001)

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