Kipkorir, Florence C.2018-04-102018-04-102002-04http://ir-library.ku.ac.ke/handle/123456789/18301A Thesis Submitted in Partial Fulfilment of the Requirements for the Award of the Degree of Master of Public Health and Epidemiology of Kenyatta University.Malaria has remained the main cause of morbidity and mortality over the last twenty years contributing to about 40% of all illnesses in Kenya. The increasing resurgence and severity of malaria is not well understood. Global warming and vector conquest of hitherto malaria-free Highlands of Kenya could be contributing factors, but it is difficult to ignore the possible contribution of changed health care financing (cost sharing) to malaria resurgence and increased mortality. This study was aimed at establishing the possible effects of cost sharing on levels of malaria morbidity and mortality in Kericho District. Kericho district has a large population of relatively poor people and malaria is endemic in its lowlands and experiences epidemics in the highlands. The introduction of structural adjustment programmes including cost-sharing (user charges) in health facilities could have a devastating impact on the poor members of this community with consequent exacerbation of malaria related morbidity and mortality. This is because the effect of price demand for health services is higher for low-income groups than in high-income groups The results from Hospital records questionnaires and focus group discussions showed that malaria was leading among the top ten diseases in the district, and was the main cause of the disease burden in Kericho District. The majority of the study subjects (74.2%) lived within 4kms from the nearest health facility and yet attended the health facility infrequently when sick. The reasons given for irregular attendance was lack of finance in (50.7.6%) or lack of medical facilities (30.5%). The introduction of user charges contributed to less use of medical services as given by 69.1% of study subject resulting in delay in seeking health care as a response to the XII introduction of userchrges. The study subjects who opted to go for cheaper over the counter drugs that were probably not effective against malaria infection were 87.5%, this may have lead to admission of more severe cases of malaria in the health facilities subsequent to the introduction of user charges. The information from this study is useful in designing malaria control programmes aimed at reducing morbidity and mortality and related economic losses associated with human malaria in the study area and elsewhere in Kenya. The study on the effects of user charges on malaria morbidity and mortality is second to none and it forms a base for future researches on effects of introduction of usercharges in Government health facilities, especially on the poor in malaria endemic areas of Kenya.enThesis