Improving malaria home treatment by training drug retailers in rural Kenya


V. M. Marsh (corresponding author), W. M. Mutemi, Karisa Bayah and K. Marsh, Kenya Medical Research Institute (KEMRI) – Wellcome Trust Collaborative Research Programme, PO Box 230, Kilifi, Kenya. Tel.: +254 415 22063; Fax: +254 415 22390; E-mail:,,,
A. Willetts, Clinical Research Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. Tel.: +44 151 7053271; Fax: +44 7079193; E-mail:
S. Were, Medical Officer of Health, Kilifi District, PO Box 9, Kilifi, Kenya. Tel.: +254 22 462835; E-mail:
A. Ross, Department of Public Health and Epidemiology, Swiss Tropical Institute, Socinstrasse 57, 4002 Basel, Switzerland. Tel.: +41 61 284 8112; Fax: +41 61 271 7951; E-mail:


Recent global malaria control initiatives highlight the potential role of drug retailers to improve access to early effective malaria treatment. We report on the findings and discuss the implications of an educational programme for rural drug retailers and communities in Kenya between 1998 and 2001 in a study population of 70 000. Impact was evaluated through annual household surveys of over-the-counter (OTC) drug use and simulated retail client surveys in an early (1999) and a late (2000) implementation area. The programme achieved major improvements in drug selling practices. The proportion of OTC anti-malarial drug users receiving an adequate dose rose from 8% (n = 98) to 33% (n = 121) between 1998 and 1999 in the early implementation area. By 2001, and with the introduction of sulphadoxine pyrimethamine group drugs in accordance with national policy, this proportion rose to 64% (n = 441) across the early and late implementation areas. Overall, the proportion of shop-treated childhood fevers receiving an adequate dose of a recommended anti-malarial drug within 24 h rose from 1% (n = 681) to 28% (n = 919) by 2001. These findings strongly support the inclusion of private drug retailers in control strategies aiming to improve prompt effective treatment of malaria.