The magnitude and trend of artemether-lumefantrine stock-outs at public health facilities in Kenya.

Journal article

BACKGROUND: Health facility stock-outs of artemether-lumefantrine (AL), the common first-line therapy for uncomplicated malaria across Africa, adversely affect effective malaria case-management. They have been previously reported on various scales in time and space, however the magnitude of the problem and trends over time are less clear. Here, 2010-2011 data are reported from public facilities in Kenya where alarming stock-outs were revealed in 2008. METHODS: Data were collected between January 2010 and June 2011 as part of 18 monthly cross-sectional surveys undertaken at nationally representative samples of public health facilities. The primary monitoring indicator was total stock-out of all four weight-specific AL packs. The secondary indicators were stock-outs of at least one AL pack and individual stock-outs for each AL pack. Monthly proportions and summary means of the proportions over the monitoring period were measured for each indicator. Stock-out trends were assessed using linear regression. RESULTS: The number of surveyed facilities across 18 time points ranged between 162 and 176 facilities. The stock-out means of the proportion of health facilities were 11.6% for total AL stock-out, 40.6% for stock-out of at least one AL pack, and between 20.5% and 27.4% for stock-outs of individual AL packs. Monthly decrease of the total AL stock-out was 0.005% (95% CI: -0.5 to +0.5; p = 0.983). Monthly decrease in the stock-out of at least one AL pack was 0.7% (95% CI: -1.5 to +0.3; p = 0.058) while stock-outs of individual AL packs decreased monthly between 0.2% for AL 24-pack and 0.7% for AL six-pack without statistical significance for any of the weight-specific packs. CONCLUSIONS: Despite lower levels of AL stock-outs compared to the reports in 2008, the stock-outs at Kenyan facilities during 2010-2011 are still substantial and of particular worry for the most detrimental:- simultaneous absence of any AL pack. Only minor decrease was observed in the stock-outs of individual AL packs. Recently launched interventions to eliminate AL stock-outs in Kenya are fully justified.

Authors: Sudoi, R; Githinji, S; Nyandigisi, A; Muturi, A; Snow, R

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BioMed Central
• Journal: Malaria journal
• Volume: 11
• Issue: 1
• Article number: 37
• Publication date: 2012-01-01
• DOI: 10.1186/1475-2875-11-37
• EISSN: 1475-2875
• ISSN: 1475-2875
• Language: English
• Keywords: Artemisinins; Antimalarials; Fluorenes; Ethanolamines; Drug Combinations; Malaria; Cross-Sectional Studies; Health Facilities; Plasmodium falciparum; Kenya; Humans