The Impact of Retail-Sector Delivery of Artemether-Lumefantrine on Malaria Treatment of Children under Five in Kenya: A Cluster Randomized Controlled Trial
The Impact of Retail-Sector Delivery of Artemether-Lumefantrine on Malaria Treatment of Children under Five in Kenya: A Cluster Randomized Controlled Trial
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DOI：
10.1371/journal.pmed.1000437
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发表时间：
2011-05-01
期刊：
影响因子：
15.8
通讯作者：
Goodman, Catherine A.
中科院分区：
文献类型：
--
作者：
Kangwana, Beth P.;Kedenge, Sarah V.;Goodman, Catherine A.
背景：有人建议私营部门补贴以青蒿素为基础的联合疗法（ACT），以提高可负担性和可及性。这项在肯尼亚西部进行的研究旨在评估通过零售供应商提供有补贴的蒿甲醚-氨苯曲明（AL）对3-59个月发热儿童及时、有效的抗疟疾治疗覆盖率的影响。方法和研究结果：我们采用集群随机对照设计，有9个对照亚位和9个干预亚位，均匀分布在肯尼亚西部的三个地区。在干预措施实施前后进行了横断面家庭调查。干预措施包括向零售店提供儿科ACT补贴包、零售店工作人员培训和社区宣传活动。主要终点定义为过去2周内报告发热的3-59个月儿童在发热当天或次日开始AL治疗的比例。使用结构化问卷收集数据，并基于聚类水平总结进行分析，比较对照组和干预组，同时调整其他协变量。数据收集了2,749名目标年龄组儿童的基线数据和2,662名随访数据。29%的儿童在访谈前2周内发烧。随访时，在发热当天或次日接受AL治疗的儿童比例在对照组上升了14.6%（从5.3%[标准差（SD）： 3.2%]上升到19.9% [SD: 10.0%]），在干预组上升了40.2%（从4.7% [SD: 3.4%]上升到44.9% [SD: 11.7%]）。随访时，干预组接受AL治疗的儿童比例显著高于干预组，两组间差异为25.0%（95%可信区间[CI]: 14.1%, 35.9%；未调整p = 0.0002，调整p = 0.0001）。在按来源为其儿童发烧寻求治疗的护理人员比例或儿童对al的依从性方面，两组间未观察到显著差异。结论：补贴零售部门的ACT可显著提高农村地区报告发烧的ACT覆盖率。需要进一步研究这种补贴方案在国家范围内的影响和成本效益。试验注册：当前对照试验ISRCTN59275137和肯尼亚药学和毒物委员会临床试验伦理委员会PPB/ECCT/08/07。
Background: It has been proposed that artemisinin-based combination therapy (ACT) be subsidised in the private sector in order to improve affordability and access. This study in western Kenya aimed to evaluate the impact of providing subsidized artemether-lumefantrine (AL) through retail providers on the coverage of prompt, effective antimalarial treatment for febrile children aged 3-59 months.Methods and Findings: We used a cluster-randomized, controlled design with nine control and nine intervention sublocations, equally distributed across three districts in western Kenya. Cross-sectional household surveys were conducted before and after the delivery of the intervention. The intervention comprised provision of subsidized packs of paediatric ACT to retail outlets, training of retail outlet staff, and community awareness activities. The primary outcome was defined as the proportion of children aged 3-59 months reporting fever in the past 2 weeks who started treatment with AL on the same day or following day of fever onset. Data were collected using structured questionnaires and analyzed based on cluster-level summaries, comparing control to intervention arms, while adjusting for other covariates. Data were collected on 2,749 children in the target age group at baseline and 2,662 at follow-up. 29% of children experienced fever within 2 weeks before the interview. At follow-up, the percentage of children receiving AL on the day of fever or the following day had risen by 14.6% points in the control arm (from 5.3% [standard deviation (SD): 3.2%] to 19.9% [SD: 10.0%]) and 40.2% points in the intervention arm (from 4.7% [SD: 3.4%] to 44.9% [SD: 11.7%]). The percentage of children receiving AL was significantly greater in the intervention arm at follow-up, with a difference between the arms of 25.0% points (95% confidence interval [CI]: 14.1%, 35.9%; unadjusted p = 0.0002, adjusted p = 0.0001). No significant differences were observed between arms in the proportion of caregivers who sought treatment for their child's fever by source, or in the child's adherence to AL.Conclusions: Subsidizing ACT in the retail sector can significantly increase ACT coverage for reported fevers in rural areas. Further research is needed on the impact and cost-effectiveness of such subsidy programmes at a national scale.Trial Registration: Current Controlled Trials ISRCTN59275137 and Kenya Pharmacy and Poisons Board Ethical Committee for Clinical Trials PPB/ECCT/08/07.