Acccess and Utilization of Artemether Lumefantrine as First Line Non-over the Counter Treatment for Malaria in Masii Division, Mwala District, Kenya
Kioko, Jonathan M.
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Prompt and appropriate case management has remained a major challenge in the fight against malaria in Kenya especially due to limited timely access to recommended drugs and development of resistance to drugs by malaria parasites among other reasons. As a result, Kenya changed from chloroquine to Sulphur-pyremethamine (SP) based drugs in late 90's and in April 2006 to Artemether Lumefantrine (AL) as the first line antimalarial drug which is an Artemisinin based Combination Therapy (ACT). The main difference between the current first line treatment drug and the former ones is that it is restricted from being dispensed by shopkeepers at community level. Since the introduction of this drug in April 2006, no study has been conducted to establish levels of communities' timely access to the drug. This study therefore explored health seeking behaviour of selected residents of Masii Division, Mwala District in order to establish how this restriction affected timely access and utilization of AL for malaria treatment. A cross sectional study design was adopted and multi-stage sampling technique used. A total of 350 respondents who had suffered from malaria since October 2007 (for ease of recalling) were sampled and interviewed. Qualitative data was collected through Focus Group Discussion (FGDs) sessions and summarized in tables for report compilation while quantitative data was analyzed using SPSS computer package. Out of the sampled respondents, 86.6% took or administered drugs to children when they suffered from malaria. The drugs/ treatment substances were sourced from medical facilities (76.6%), chemists/ pharmacies 14%, shops 5.7%, traditional healers / herbalists 4.3%, prepared / used drug remains at home 2.3%, borrowed drugs from neighbors 0.6%, from both health facility and herbalists 0.6% while 6.3% took no action. Association between seeking treatment from health facilities and utilizing AL for malaria treatment had strong statistical significance. Out of the 303 people who used drugs only 8.9% (27) took AL and adhered to prescription. Of those respondents who visited health facilities, slightly less than half (41.4%) got all the anti-malarial drugs. Majority (77.1 %) of the respondents reported to have at least one bed net in their households while the rest (22.9%) did not have. Access to health facilities was found to be average as 54.6% of the respondents took one hour or less to get to the nearest health facility. However, there was no statistically signi ficant association between access to health facilities and utilization of AL for malaria treatment. Only 5.7% of respondents knew the correct first line treatment for malaria. Knowledge of AL as the first line treatment for malaria and its utilization for malaria treatment had statistically significant association. In conclusion access and utilization of AL for malaria treatment was very low in the area and malaria continues to pose a major challenge to the community. There is therefore need for extensive awareness creation on signs and symptoms of malaria and promotion of AL utilization for malaria treatment in the community. Further, integrated malaria prevention approaches need to be embraced for effective reduction of malaria burden as there is no single magic bullet.