Kenya Outlet Report 2014

Transcription

Evidence for Malaria Medicines Policy
ACTwatch Study Reference Document
Republic of Kenya
2014
www.ACTwatch.info
Copyright © Population Services International (PSI). All rights reserved.
Released 23 February 2016
Suggested citation
ACTwatch Group and Population Services Kenya (PSK). (2015). ACTwatch Study Reference Document:
Republic of Kenya Outlet Survey 2014. Washington DC: PSI.
Contact
Dr. Megan Littrell
ACTwatch Principal Investigator
PSI | 1120 19th St NW Suit 600
Washington DC 20036
[email protected]
Country contact
Julius Ngigi
Population Services International, ACTwatch
Whitefield place, School Lane, Westlands
P.O. Box 14355-00800, Nairobi
Acknowledgements
ACTwatch is funded by the Bill and Melinda Gates Foundation, UNITAID, and the UK Department for International
Development. This study was implemented by Population Services International (PSI).
ACTwatch Team
Andrew Andrada
Erick Auko
Dr. Hana Bilak
Dr. Desmond Chavasse
Kevin Duff
Gloria Kigo
Tarryn Haslam
Catharine Hurley
Dr. Megan Littrell
Julius Ngigi
Ricki Orford
Stephen Poyer
Dr. Justin Rahariniaina
Dr. Andria Rusk
Julianna Smith
Raymond Sudoi
Kenya Malaria Control Unit
Dr. Rebecca Kiptui
Dr. Andrew Nyandigisi
Kenya Pharmacy and Poisons Board
Dr. Edward Abwao
PS Kenya
Dr. Anne Musuva
Data Collection Management
Ipsos:
Samuel Muthoka
Oscar Mutinda
Hulda Kibera
Anne Wanyingi
James Ombasa
Philemon Rono
Lydia Wang’aya
Regional Coordinators
Questionnaire Traffic control
John Maingi
Rodgers Kegode
Dickens Nyamogo
Mary Omondi
Gerald Musundi
Pamela Kuya
Quality Control Team
Anthony Njeru
Eunice Mokua
Cidee Khaseke
Edwin Ochieng Oluko
Helen Kimanthi
Shobby Ekasiba
Hamida Omar
Prudencial Bosibori
Joan Chebet
Sophie June
Alfred Luchivia
Nancy Makio
Salome Omondi
Purity Kimuru
Coding Clerks
Brenda Yonga
Martha Abucherry
Elizabeth Lango
Elvis Matthews
Joseph Ogeto
Teresa Mumbi
Ann Nyawira Kiai
Samwel Kimani
David Owino
Edwin Otieno
Gerald Njoroge
Enumerators
Sicily Kamuri
Tom Ruto
Amina Day
Janet Obare
Victor Nduku
Rosemary Okoth
Maureen Okumu
Bevarlyne Kadenyi
Linda Kwamboka
Joshua Mwasia
Bendetta Kathina Moses
Angela Williams
Munyan Ian
Nickson Leiyan
Monicah Ireri
Laban Kibet
Linda Norah
Stephen Ouma
Marlon Githua
J.M. Makori
Julie Sumba
Jackline Nduta
Harmony Momanyi
Mary Lagat
Betty Mumo
Joram Mburu
Paul Mboya
Supervisors
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Enumerators
Innocent Omondi
Brian Muchai
Christine Rwanda Muthoni
Anne Mugo
Robert Muriithi
Vincent Depaul
Michael Omondi
Faith Vutagua
Jude Semut
Mercy Ramogo
Elijah Rogers
Caroline Nelima
Richard Njoroge
Osborn Nyambare
Edwin Nyarango
Bernard Omondi W.
Robert Kamau
Agnes Karimi
James Mutua
Caroline Wangare
Bridie Mwema
Julius Kitela
Stephen Oguna
Diana Omolo
Roselida Obiero
James Nzioki
Malachi Ayega
Caroline Muli
Samuel Rachuonyo
Abraham Kisundi
Daisy Nyambura
Irene Mutisya
Catherine Onchuati
Collins Ouko
Wambui Gitau
Jacinta Kyusa
Fredrick Aika
Armstrong Andaje
Caleb Bosire
Sophia Ngaire
James Kitheka
Jane Wanza
Teresa Moraa
Francis Nyakundi
William Chepkwony
Jacinter Mbaika
Brian Masika
Ben Nduati
Martin Mugendi
Wendy Macharia
Edith Mukhongo
Sylvia Natasha
Monicah Naisianoi
Philemon Rono
Kevin Onchama
Naomi Nyarangi
Nicholas Muriuki
Florence Otieno
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Table of Contents
List of Tables ...................................................................................................................................................... 4
List of Figures ..................................................................................................................................................... 6
Definitions .......................................................................................................................................................... 9
Introduction ..................................................................................................................................................... 11
Summary of Methods and Data Collection ...................................................................................................... 12
Summary of Key Findings ................................................................................................................................. 14
Results Section A: Core Indicators ................................................................................................................... 38
Results Section B: Core Indicators across Urban/Rural Location .................................................................... 54
Results Section C: Core Indicators by Type of Public Health Facility ............................................................... 79
Results Section D: Core Indicators across Survey Round: 2010, 2011, 2014 .................................................. 83
Annex 1: ACTwatch Background .................................................................................................................... 100
Annex 2: Kenya Background .......................................................................................................................... 103
Annex 3: Outlet Survey Methods ................................................................................................................... 107
Annex 4: Sampled Locations .......................................................................................................................... 112
Annex 5: Detailed Sample Description .......................................................................................................... 117
Annex 6: Questionnaire ................................................................................................................................. 119
Annex 7: Antimalarial Reference ................................................................................................................... 137
Annex 8: RDT Reference ................................................................................................................................ 141
Annex 9. Sampling Weights ........................................................................................................................... 143
Annex 10: Indicator Definitions ..................................................................................................................... 145
Annex 11. Adult Equivalent Treatment Dose (AETD) .................................................................................... 153
Annex 12: Antimalarial Volumes.................................................................................................................... 155
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List of Tables
Results Core Indicators
Table S1: Key results, by outlet type - 2014.................................................................................................................... 14
Table A1: Availability of antimalarials, among all screened outlets, by outlet type....................................................... 38
Table A2: Availability of antimalarials, among outlets stocking at least one antimalarial, by outlet type..................... 40
Table A3: Antimalarial market composition ................................................................................................................... 42
Table A4a: Price of tablet formulation antimalarials, by outlet type ............................................................................. 43
Table A4b: Price of pre-packaged antimalarials, by outlet type ..................................................................................... 44
Table A5: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type.......................... 45
Table A6: Malaria blood testing market composition .................................................................................................... 46
Table A7: Price of malaria blood testing, by outlet type ................................................................................................ 47
Table A8: Antimalarial market share .............................................................................................................................. 48
Table A9: Antimalarial market share across outlet type ................................................................................................ 49
Table A10: Malaria blood testing market share ............................................................................................................. 50
Table A11: Malaria blood testing market share, across outlet type............................................................................... 51
Table A12: Provider case management knowledge and practices, by outlet type......................................................... 52
Table A13: Provider antimalarial treatment knowledge and practices, by outlet type ................................................. 53
Results Across Urban/Rural Location
Table B1: Availability of antimalarials, among all screened outlets, by outlet type, across urban/rural location ......... 54
Table B2: Availability of antimalarials, among all outlets stocking at least one antimalarial, by outlet type, across
urban/rural location ............................................................................................................................................... 59
Table B3: Antimalarial market composition, across urban/rural location...................................................................... 64
Table B4a: Price of tablet formulation antimalarials, by outlet type, across urban/rural location ................................ 65
Table B4b: Price of pre-packaged antimalarials, by outlet type, across urban/rural location ....................................... 67
Table B5: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type, across
urban/rural location ............................................................................................................................................... 68
Table B7: Price of malaria blood testing, by outlet type, across urban/rural location ................................................... 69
Table B8a: Antimalarial market share, urban ................................................................................................................. 71
Table B8b: Antimalarial market share, rural ................................................................................................................... 72
Table B9a: Antimalarial market share across outlets, urban .......................................................................................... 73
Table B9b: Antimalarial market share across outlets, rural............................................................................................ 74
Table B12: Provider case management knowledge and practices, by outlet type, across urban/rural location ........... 75
Table B13: Provider antimalarial treatment knowledge and practices, by outlet type, across urban/rural location .... 77
Results by Type of Public Health Facility
Table C1: Availability of antimalarials, among screened outlets, by type of public health facility ................................ 79
Table C2: Availability of antimalarials, among outlets stocking at least one antimalarial, by type of public health
facility ..................................................................................................................................................................... 80
Table C5:
Availability of malaria blood testing among antimalarial-stocking outlets*, by type of public health
facility……………………………………………………………………………………………………………………………………………………………….81
Table C12:
Provider antimalarial treatment knowledge and practices, by type of public health facility .............. 82
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Results Across Survey Round: 2010, 2011, 2014
Table D1: Availability of antimalarials, among all screened outlets, by outlet type, across survey round .................... 83
Table D2: Availability of antimalarials, among outlets stocking at least one antimalarial, by outlet type, across survey
round ...................................................................................................................................................................... 87
Table D3: Antimalarial market composition, across survey round ................................................................................. 90
Table D4: Price of tablet formulation antimalarials in 2010 USD, by outlet type, across survey round ........................ 91
Table D5: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type, across survey
round ...................................................................................................................................................................... 94
Table D7: Price of malaria blood testing in 2010 USD, by outlet type, across survey round ......................................... 95
Table D8: Antimalarial market share, across survey round ............................................................................................ 96
Table D9: Antimalarial market share, across outlet type, across survey round ............................................................. 97
Table D12: Provider antimalarial treatment knowledge and practices, by outlet type, across survey round ............... 98
Annexes
Table X1. Sampled locations ......................................................................................................................................... 112
Table X2: Detailed sample description ......................................................................................................................... 117
Table X3: Number of antimalarials audited .................................................................................................................. 137
Table X4: Quality-Assured (QA ACT) and Non-Quality Assured ACTs ........................................................................... 137
Table X5: Nationally Registered ACTs ........................................................................................................................... 139
Table X6: Severe Malaria Treatment ............................................................................................................................ 140
Table X7: Number of RDTs audited ............................................................................................................................... 141
Table X8: RDT Brand Names and Manufacturers* ....................................................................................................... 142
Table X9: Adult Equivalent Treatment Dose Definitions .............................................................................................. 154
Table X10: Antimalarial volumes, by outlet type .......................................................................................................... 155
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List of Figures
Figure 1. Survey flow diagram, Kenya, 2014 ................................................................................................................... 13
Figure 2. Market composition: outlet type distribution, 2010-2014 .............................................................................. 16
Figure 3. Market composition: outlet type distribution, 2014, urban/rural .................................................................. 16
Figure 4. Percentage of outlets with at least one antimalarial in stock on the day of the survey, 2010-2014 .............. 17
Figure 5. Percentage of outlets with at least one antimalarial in stock on the day of the survey, 2014, urban/rural... 17
Figure 6. Percentage of antimalarial-stocking outlets with ACT in stock on the day of the survey, 2010-2014 ............ 18
Figure 7. Percentage of antimalarial-stocking outlets with ACT in stock on the day of the survey, 2014, urban/rural 18
Figure 8. Percentage of antimalarial-stocking outlets with quality-assured ACT in stock on the day of the survey,
2010-2014 .............................................................................................................................................................. 19
Figure 9. Percentage of antimalarial-stocking outlets with quality-assured ACT in stock on the day of the survey,
2014, urban/rural ................................................................................................................................................... 19
Figure 10. Percentage of antimalarial-stocking outlets with quality-assured ACT marked with the ‘green leaf’ logo in
stock on the day of the survey, 2010-2014 ............................................................................................................ 20
Figure 11. Percentage of antimalarial-stocking outlets with quality-assured ACT marked with the ‘green leaf’ in stock
on the day of the survey, 2014, urban/rural .......................................................................................................... 20
Figure 12. Percentage of antimalarial-stocking outlets with non-quality-assured ACT in stock on the day of the survey,
2010-2014 .............................................................................................................................................................. 21
Figure 13. Percentage of antimalarial-stocking outlets with non-quality-assured ACT in stock on the day of the survey,
2014, urban/rural ................................................................................................................................................... 21
Figure 14. Types of quality-assured ACT and non-quality-assured ACT found among public and private ..................... 22
sector outlets, 2014 ........................................................................................................................................................ 22
Figure 15. Percentage of antimalarial-stocking outlets with non-artemisinin therapy in stock on the day of the survey,
2010-2014 .............................................................................................................................................................. 23
Figure 16. Percentage of antimalarial-stocking outlets with non-artemisinin therapy in stock on the day of the survey,
2014, urban/rural ................................................................................................................................................... 23
Figure 17. Percentage of antimalarial-stocking outlets with SP in stock on the day of the survey, 2010-2014 ............ 24
Figure 18. Percentage of antimalarial-stocking outlets with SP in stock on the day of the survey, 2014, urban/rural . 24
Figure 19. Percentage of antimalarial-stocking outlets with SP in stock on the day of the survey, by regions targeted
or not targeted for IPTp, 2014................................................................................................................................ 25
Figure 20. Percentage of antimalarial-stocking outlets with any severe malaria treatment in stock on the day of the
survey, 2010-2014 .................................................................................................................................................. 26
Figure 21. Percentage of antimalarial-stocking outlets with any severe malaria treatment in stock on the day of the
survey, 2014, urban/rural....................................................................................................................................... 26
Figure 22. Antimalarial market share, 2010-2014 .......................................................................................................... 27
Figure 23. Antimalarial market share within sector, 2010-2014 .................................................................................... 27
Figure 24. Antimalarial market share, 2014.................................................................................................................... 28
Figure 25. Antimalarial market share, 2014, urban/rural ............................................................................................... 28
Figure 26. Percentage of antimalarial-stocking outlets with malaria blood testing available, 2010-2014 .................... 29
Figure 27. Percentage of antimalarial-stocking outlets with malaria blood testing available, 2014, urban/rural ......... 29
Figure 28. Percentage of antimalarial-stocking outlets with malaria microscopy available, 2010-2014 ....................... 30
Figure 29. Percentage of antimalarial-stocking outlets with malaria microscopy available, 2014, urban/rural............ 30
Figure 30. Percentage of antimalarial-stocking outlets with malaria RDTs, 2010-2014................................................. 31
Figure 31. Percentage of antimalarial-stocking outlets with malaria RDTs, 2014, urban/rural ..................................... 31
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Figure 32. Malaria blood testing market share, 2014 ..................................................................................................... 32
Figure 33. Malaria RDT market share by manufacturer, across sector, 2014 ................................................................ 32
Figure 34. Private sector median price of antimalarial adult equivalent treatment dosages (AETD),
2010-2014 .... 33
Figure 35. Private sector median price of QA ACT adult equivalent treatment dosages (AETD) with and .................... 33
without the ‘green leaf’ logo, 2010-2014 ....................................................................................................................... 33
Figure 36. Private sector median price of SP and quality-assured ACT adult equivalent treatment dosages (AETD) and
pre-packaged pediatric quality-assured AL, 2014 .................................................................................................. 34
Figure 37. Private sector median price of SP and quality-assured ACT adult equivalent treatment dosages (AETD) and
pre-packaged pediatric quality-assured AL, 2014, urban/rural ............................................................................. 34
Figure 38. Median private sector consumer prices for malaria RDT testing for adults and children 2014 .................... 35
Figure 39. Percentage of providers who correctly state the first-line treatment for uncomplicated malaria, 2010-2014
................................................................................................................................................................................ 36
Figure 40. Percentage of providers who correctly state the first-line treatment for uncomplicated malaria, 2014,
urban/rural ............................................................................................................................................................. 36
Figure 41. Percentage of providers who correctly state the first-line dosing regimen for uncomplicated malaria for a
two-year old child, 2010-2014 ............................................................................................................................... 37
Figure 42. Percentage of providers who correctly state the first-line dosing regimen for uncomplicated malaria for a
two-year old child, 2014, urban/rural .................................................................................................................... 37
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Acronyms
ACT
AETD
AL
AMFm
ASAQ
BMGF
CHW
DFID
DHA PPQ
DOMC
EMA
IM
Artemisinin combination therapy
Adult equivalent treatment dose
Artemether lumefantrine
Affordable Medicines Facility – malaria
Artesunate amodiaquine
The Bill and Melinda Gates Foundation
Community Health Worker
Department for International Development
Dihydroartemisinin piperaquine
Division of Malaria Control
European Medicines Agency
Intramuscular injection
IPT
IQR
IRS
ITN
IV
Kg
KII
KNBS
KNMS
KSH
Mg
MOH
MOMS
MOPHS
NGO
Pf
PMI
PPS
QA
RDT
SP
USAID
USD
WHO
Intermittent Preventive Treatment
Interquartile Range
Indoor Residual Spraying
Insecticide Treated Net
Intravenous injection
Kilogram
Key Informant Interview
Kenya National Bureau of Statistics
Kenya National Medical Services
Kenya Shillings
Milligrams
Ministry of Health
Ministry of Medical Services
Ministry of Public Health and Sanitation
Non-governmental Organization
Plasmodium falciparum
President’s Malaria Initiative
Probability proportional to size
Quality-assured
Rapid diagnostic test
Sulfadoxine‐pyrimethamine
United States Agency for International Development
United States Dollar
World Health Organization
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Definitions
Survey Methods Definitions
Outlet
Outlets eligible for
inclusion in the
study
Cluster
Censused location
Booster Sample
Any service delivery point or point of sale for commodities. Outlets are not restricted to
stationary points of sale and may include mobile units or individuals.
Outlets were administered a full questionnaire if they met at least one of three inclusion
criteria: (1) had one or more antimalarials in stock at the time of the survey visit; (2) reportedly
had one or more antimalarials in stock in the previous three months; or (3) provide malaria
blood testing (microscopy or rapid diagnostic tests) but do not provide antimalarial treatment.
Outlets not providing services to the general public (e.g. army and military clinics) were
excluded from the study.
The primary sampling unit, or cluster, for the outlet survey. It is an administrative unit
determined by the Kenya National Bureau of Statistics (KNBS) that hosts a population size of
approximately 10,000 to 15,000 inhabitants. These units are defined by political boundaries.
In country, they were defined as locations.
A locality where field teams conducted a full census of all outlets with the potential to sell
antimalarials.
A booster sample was collected by extending the primary sampling unit to a higher
administrative unit for sampling certain outlet types. This extension achieves a larger sample
size for specific outlets, allowing for estimates among key outlet types. In this survey, a booster
sample was collected for public health facilities and pharmacies. The administrative unit for
the census of public health facilities and pharmacies was extended beyond location to the
Division level. See Annex 9 for a detailed description of the booster sampling methods.
Malaria Product Indicator Definitions
Antimalarial
Dosing/treatment
regimen
Adult Equivalent
Treatment Dose
(AETD)
Monotherapy
Artemisinin and its
derivatives
Artemisinin-based
Combination
Therapy (ACT)
Any medicine recognized by the WHO for the treatment of malaria. Medicines used solely for
the prevention of malaria were excluded from analysis of key indicators in this report.
The posology or timing and number of doses of an antimalarial used to treat malaria. This
schedule often varies by patient weight.
An AETD is the number of milligrams (mg) of an antimalarial drug required to treat a 60 kg
adult (see Annex 11).
An antimalarial medicine that has a single mode of action. This may be a medicine with a single
active compound or a synergistic combination of two compounds with related mechanisms of
action.
Artemisinin is a plant extract or synthetic plant extract used in the treatment of malaria. The
most common derivatives of artemisinin used to treat malaria are artemether, artesunate, and
dihydroartemisinin.
An antimalarial that combines artemisinin or one of its derivatives with an antimalarial or
antimalarials of a different class.
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Artemisinin
monotherapy
Oral artemisinin
monotherapy
Non-artemisinin
therapy
First-line
treatment
Second-line
treatment
Nationally
registered ACTs
Severe malaria
treatment
Quality-assured
Artemisinin-Based
Combination
Therapies (QA
ACTs)
Quality-assured
ACT with the
“green leaf” logo,
or “co-paid ACTs”
Quality-assured
RDT
RDT with the
“checkmark” logo
1
An antimalarial medicine that has a single active compound, where this active compound is
artemisinin or one of its derivatives.
Artemisinin or one of its derivatives in a dosage form with an oral route of administration.
These include tablets, suspensions, and syrups and exclude suppositories and injections.
An antimalarial medicine that does not contain artemisinin or any of its derivatives.
The government recommended treatment for uncomplicated malaria. Kenya’s first‐line
treatment is Artemether Lumefantrine.
The government recommended second-line treatment for uncomplicated malaria. Kenya's
second-line treatment for uncomplicated malaria is Dihydroartemisinin-Piperaquine.
ACTs registered with a country’s national drug regulatory authority and permitted for sale or
distribution in country. Each country determines its own criteria for placing a drug on its
nationally registered listing.
WHO recommends parenteral artesunate as first-line treatment in the management of severe
falciparum malaria, with artemether or quinine injections as acceptable alternatives if
parenteral artesunate is not available1. If complete treatment for severe malaria is not
possible, patients with severe malaria should be given pre-referral treatment and referred
immediately to an appropriate facility for further treatment. The following are options for prereferral treatment: rectal artesunate, injectable quinine, injectable artesunate and injectable
artemether.
QA ACTs are ACTs that comply with the Global Fund to Fight AIDS, Tuberculosis and Malaria’s
Quality Assurance Policy. A QA ACT is any ACT that appeared on the Global Fund's indicative
list of antimalarials meeting the Global Fund's quality assurance policy prior to data collection
(see
http://www.theglobalfund.org/en/procurement/quality/pharmaceutical/), or that
previously had C-status in an earlier Global Fund quality assurance policy and was used in a
program supplying subsidized ACTs. QA ACTs also include ACTs that have been granted
regulatory approval by the European Medicines Agency (EMA) – specifically Eurartesim® and
Pyramax®.
The “green leaf” logo indicates that a quality-assured ACT was acquired through
a co-payment mechanism administered by the Global Fund (Affordable
Medicines Facility, malaria – or AMFm). These subsidized (co-paid) qualityassured ACTs were available to first-line buyers in Country in the public and
private sector from 2010.
QA RDTs are RDTs that comply with the Global Fund to Fight AIDS, Tuberculosis and Malaria’s
Quality Assurance Policy. A QA RDT is any RDT that appeared on the Global Fund's indicative
list of RDTs meeting the Global Fund's quality assurance policy prior to data collection (see
http://www.theglobalfund.org/en/procurement/quality/diagnostics/#Quality).
The “checkmark” logo indicates that a quality-assured RDT was acquired
through a co-payment mechanism. These subsidized RDTs were available
to private sector pharmacies and health facilities from August 2013.
World Health Organization. (2010). Guidelines for the treatment of malaria, 2nd edition. Geneva: WHO.
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Introduction
This Kenya reference document is a detailed presentation of the 2014 national ACTwatch outlet survey (OS) conducted
in Kenya. The 2014 OS follows previous survey rounds conducted as part of the Independent Evaluation of the
Affordable Medicines Facility, malaria (AMFm) in 2010 and 2011.
ACTwatch is a multi-country research project implemented by PSI (www.psi.org). Standardized tools and approaches
are employed to provide comparable data across countries and over time. ACTwatch is designed to provide timely,
relevant, and high quality antimalarial market evidence. The goal of providing this market evidence is to inform and
monitor national and global policy, strategy, and funding decisions for improving malaria case management. The
project was launched in 2008 with funding from the Bill and Melinda Gates Foundation (BMGF), and is currently funded
through 2016 by the BMGF, UNITAID, and DFID. See Annex 1 for more information about the ACTwatch project.
Antimalarial market monitoring in Kenya from 2010 to present has been implemented in the context of strategies
designed and implemented to improve coverage of appropriate case management. These include:


Scale up of quality-assured ACTs in the public and private sectors through mechanisms including the Global
Fund co-payment mechanism piloted under the AMFm. The initial AMFm pilot period was 2010-2011 and copaid ACTs were delivered to first-line buyers in Kenya from 2010-2014
National efforts to improve availability of malaria blood testing and confirmatory testing prior to antimalarial
treatment in both the public and private sectors.
The 2014 OS was the third round of outlet surveys conducted in Kenya. This report presents trend lines with three
data points: 1) the 2010 outlet survey; 2) the 2011 outlet survey; and 3) the most recent 2014 survey. These surveys
are designed to monitor key antimalarial market indicators at national level and within urban/rural domains. ACTwatch
outlet survey findings can inform ongoing monitoring, evaluation, and adjustment to policy, strategy, and funding
decisions to strengthen malaria case management.
Report notes




This document is a complete reference for the 2015 outlet survey. Please see annexes for information about the
study context, design, implementation and data analysis.
Table numbers are consistent across all sections (not including the annex tables), and are reflective of table
descriptions available in Annex 10
Grey text for data appearing in report tables indicates that the estimate provided was derived from a small
sample size. Specifically, grey text is used to indicate point estimates derived from an n of less than 50 and
median prices derived from an n of less than 5.
Malaria testing and treatment prices are reported in US dollars. Price information is captured in local currency
and converted to US dollars based on exchange rates available from www.oanda.com using the historical
exchange rates tool. The average exchange rate over the entire data collection period is used for converting local
currency captured during data collection to US dollars.
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Summary of Methods and Data Collection
A nationally-representative antimalarial outlet survey was conducted in Kenya between November 7, 2014 and
December 22, 2014. A full description of research design and methods is provided in Annex 3. Briefly, a representative
sample of locations was selected from urban and rural domains (see sampled locations in Annex 4). Within selected
clusters, a census of all outlets with the potential to sell or distribute antimalarials and/or provide malaria blood testing
was completed. The geographic area for sampling outlets was extended to the division level to achieve a sufficient
sample size for estimating key indicators for important outlet types. This booster sampling strategy was used to obtain
a sufficient sample size for indicator estimates within public health facilities and pharmacies.
Outlets were screened to determine eligibility. Outlets eligible for the survey met at least one of three criteria: 1) one
or more antimalarials were in stock on the day of the survey; 2) one or more antimalarials were in stock in the three
months preceding the survey; and/or 3) malaria blood testing (microscopy or RDT) was available. Outlets that do not
serve the general public (e.g. military facilities) were excluded from the study. The results of the census are
summarized in Figure 1. A detailed sample summary is provided in Annex 5.
A structured questionnaire was used to complete an audit of all antimalarials and RDTs as well as a provider interview
(see Annex 6). See Annex 7 and Annex 8 for detailed summaries of antimalarials and RDTs audited.
Double data entry was completed using Microsoft Access. All data cleaning and analysis was performed using Stata
13.1 (©StataCorp, College Station, TX). Data were weighted to account for variation in probability of outlet selection
(see Annex 9), and standard error calculation reflected clustering of outlets at location and division levels. Standard
indicators were constructed according to definitions applied across ACTwatch project countries (see Annex 10).
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Figure 1. Survey flow diagram, Kenya, 2014
A
Outlets enumerated*
14,127
Outlets not
screened
1,451
B
Outlets screened**
12,676
Respondent not available
95
Outlet closed at time of visit
324
Outlet closed permanently
798
Other
182
Refused
52
Respondent not available
6
Outlet closed at time of visit
3
Other
3
Refused
16
Outlets that did not
meet screening
criteria
10,199
C
Outlets that met
screening criteria
2,477
1 = 2,159
2 = 272
3 = 46
D
Outlets not
interviewed
28
Outlets interviewed***
2,449
1 = 2,133
2= 272
3= 44
1:
2:
3:
*
Antimalarials in stock on day of visit
Antimalarials reportedly in stock during the previous 3 months but not on the day of the visit
Malaria blood testing available but no antimalarials in stock
Identified as outlets with potential to sell or distribute antimalarials and/or provide malaria blood testing during
the census or booster sampling
** Administered questions to assess current or recent (previous 3 months) availability of antimalarials and malaria
blood testing (microscopy or rapid diagnostic test)
*** A partial or complete interview was conducted with an outlet representative
www.ACTwatch.info
Page 13
Summary of Key Findings
Table S1: Key results, by outlet type - 2014
Readiness for malaria case management
Proportion of all screened outlets* with:
Availability of malaria blood testing
Availability of QA ACT
Availability of QA ACT and malaria blood
testing
Availability of QA ACT, blood testing not
available
Availability of QA ACT, malaria blood
testing, and provider correct knowledge of
first line treatment
Availability of any severe malaria treatment
Readiness for malaria case management
Proportion of antimalarial-stocking outlets
with:
Availability of malaria blood testing
Availability of QA ACT
Availability of QA ACT and malaria blood
testing
Availability of QA ACT, blood testing not
available
Availability of QA ACT, malaria blood
testing, and provider correct knowledge of
first line treatment
Availability of any severe malaria treatment
Public
Health
Facility
%
(95% CI)
ALL
Public / Not ForProfit1
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
N=485
N=1,096
92.7
(88.9, 95.2)
77.1
(72.6, 81.1)
72.7
(68.0, 77.0)
4.4
(2.3, 8.4)
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private2
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
N=453
N=503
N=572
N=9,950
N=11,580
N=12,676
19.7
(15.4, 24.9)
16.1
(12.2, 21.1)
14.4
(10.8, 19.0)
1.7
(1.2, 2.6)
67.5
(63.4, 71.3)
61.2
(57.2, 65.2)
46.9
(43.3, 50.6)
14.3
(12.2, 16.8)
20.4
(17.6, 23.6)
87.1
(84.8, 89.1)
19.5
(16.8, 22.6)
67.6
(63.7, 71.3)
15.7
(12.7, 19.3)
78.5
(76.0, 80.8)
13.8
(11.3, 16.8)
64.7
(61.5, 67.7)
0.0
0.8
(0.4, 1.3)
0.0
0.8
(0.4, 1.3)
3.5
(3.0, 4.1)
7.5
(6.7, 8.5)
2.6
(2.3, 3.1)
4.9
(4.3, 5.6)
4.7
(4.3, 5.2)
8.2
(7.4, 9.1)
3.5
(3.2, 3.9)
4.7
(4.1, 5.3)
71.9
(67.2, 76.2)
74.2
(69.5, 78.4)
14.2
(10.6, 18.8)
13.1
(9.9, 17.3)
44.6
(40.9, 48.3)
43.7
(40.3, 47.1)
19.4
(16.7, 22.5)
26.8
(22.3, 31.9)
12.7
(10.2, 15.7)
15.6
(12.1, 19.9)
0.0
0.0
(0.0, 0.1)
2.5
(2.1, 2.9)
2.7
(2.4, 3.1)
3.4
(3.0, 3.7)
3.5
(3.1, 3.8)
N=457
N=517
N=342
N=487
N=535
N=252
N=1,616
N=2,133
93.8
(89.7, 96.4)
83.4
(79.5, 86.6)
78.6
(74.2, 82.5)
4.8
(2.4, 9.0)
87.4
(83.0, 90.8)
86.8
(83.1, 89.7)
77.4
(72.8, 81.4)
9.4
(6.5, 13.4)
76.0
(72.4, 79.2)
83.6
(80.7, 86.1)
64.0
(60.8, 67.2)
19.5
(16.7, 22.7)
20.9
(17.8, 24.4)
90.5
(88.8, 92.0)
20.3
(17.3, 23.7)
70.2
(66.9, 73.3)
16.4
(13.5, 19.9)
84.2
(81.8, 86.3)
14.8
(12.1, 18.0)
69.4
(66.0, 72.5)
0.0
26.2
(15.1, 41.6)
0.0
26.2
(15.1, 41.6)
28.5
(24.8, 32.4)
70.5
(64.4, 76.0)
24.6
(21.6, 27.9)
45.9
(41.7, 50.2)
35.6
(32.5, 38.9)
72.5
(66.9, 77.5)
31.0
(28.3, 33.8)
41.5
(38.0, 45.1)
77.8
(73.3, 81.7)
80.2
(75.6, 84.1)
76.5
(71.9, 80.5)
70.6
(63.2, 77.0)
60.8
(57.2, 64.4)
59.6
(55.3, 63.7)
20.2
(17.2, 23.6)
27.9
(23.5, 32.7)
13.6
(10.9, 16.9)
16.8
(13.0, 21.4)
0.0
1.2
(0.4, 3.1)
23.3
(20.3, 26.5)
25.2
(22.1, 28.6)
29.7
(27.0, 32.6)
30.7
(27.5, 34.2)
www.ACTwatch.info
Page 14
Table S1: Key results, by outlet type - 2014
Readiness for IPTp
Proportion of outlets with SP available:
Among all screened outlets*
Among all screened outlets in endemic
regions **
Readiness for IPTp
Proportion of outlets with SP available:
Among antimalarial-stocking outlets
Among all screened outlets in endemic
regions**
Malaria market performance
% QA ACT market share within outlet type^
Median price for one QA ACT adult
equivalent treatment dose (AETD)
Median price for one pre-packaged
pediatric QA AL #
Median price for an RDT ##
Median price for malaria microscopy ##
Public
Health
Facility
N=485*
N=140**
13.9
(9.7, 19.6)
49.2
(40.0, 58.5)
N=457*
N=138**
15.0
(10.5, 21.1)
49.7
(40.4, 59.0)
ALL
Public / Not ForProfit1
N=1,096*
N=426**
3.1
(2.2, 4.2)
4.5
(3.1, 6.3)
N=517*
N=156**
16.5
(12.6, 21.3)
35.7
(27.3, 45.0)
Private
For-Profit
Facility
N=453*
N=83**
18.1
(15.7, 20.8)
17.4
(13.0, 22.8)
N=342*
N=70**
24.7
(21.7, 28.0)
22.7
(17.3, 29.1)
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private2
ALL
Outlets
N=503*
N=487**
50.8
(47.5, 54.1)
68.0
(64.1, 71.5)
N=487*
N=81**
52.8
(49.4, 56.2)
69.6
(64.9, 74.0)
N=572*
N=535**
53.6
(50.1, 56.9)
56.3
(48.1, 64.1)
N=535*
N=123**
57.5
(54.0, 60.8)
60.2
(52.3, 67.7)
N=9,950*
N=252**
1.8
(1.2, 2.6)
1.3
(0.6, 2.9)
N=252*
N=64**
62.0
(48.0, 74.3)
40.7
(27.4, 55.4)
N=11,580*
N=1,616**
5.3
(4.7, 6.0)
4.9
(4.1, 6.0)
N=1,616*
N=338**
49.6
(45.5, 53.6)
47.1
(41.1, 53.2)
N=12,676*
N=2,133**
5.1
(4.6, 5.8)
4.9
(4.0, 5.9)
N=2,133*
N=494**
45.6
(41.9, 49.3)
45.2
(40.8, 49.8)
78.9
-
76.5
-
-
-
-
-
42.5
$1.13
[1.13-1.69] (449)
$0.56
[0.45-0.90] (161)
$1.13
[1.13-1.13] (53)
$1.13
[1.13-1.13] (55)
52.7
$1.13
[1.13-1.69] (455)
$0.56
[0.56-0.79] (131)
$1.13
[1.13-1.13] (59)
$1.13
[1.13-1.13] (30)
36.0
$1.13
[1.13-1.69] (41)
$0.56
[0.56-1.13] (6)
-
47.9
$1.33
[1.13-1.69] (1,184)
$0.56
[0.56-1.13] (363)
$1.13
[1.13-1.69] (245)
$1.13
[0.56-1.13] (348)
51.4
-
-
58.9
$1.41
[1.13-1.69] (239)
$0.56
[0.56-1.13] (65)
$1.13
[1.13-1.69] (133)
$1.13
[0.56-1.13] (263)
-
1 Inclusive of N= 58 screened and 43 antimalarial-stocking private not-for-profit outlets, and N= 553 screened and 17 antimalarial-stocking community health workers.
2 Inclusive of N= 102 screened and 0 antimalarial-stocking itinerant drug vendors.
* The denominator includes 119 outlets that met screening criteria for a full interview but did not complete the interview (were not interviewed or completed a partial interview).
** Areas designated for the use of SP for the purposes of IPTp are limited to malaria endemic areas where transmission is intense throughout the year, and P. falciparum prevalence is historically greater than 20%.
These areas include altitudes ranging from sea level in the coastal area to up to 1,300 meters around the Lake Victoria basin.
 Outlets with least one antimalarial in stock on the day of the survey.
^ Percent market volume (adult equivalent treatment dosages sold/distributed in the previous week) accounted for by quality-assured ACT (QA ACT) sale/distribution within the outlet type.
# Pre-packaged QA AL for a 10kg child. Prices shown here are only for the private sector as price in public sector was free.
## Price of having test conducted, inclusive of RDT cost and consultation / service fees for a child under five. Prices shown here are only for the private sector as price in public sector was free.
Source: ACTwatch Outlet Survey, Kenya, 2014.
www.ACTwatch.info
Page 15
Figure 2. Market composition: outlet type distribution, 2010-2014
Among all outlets with at least one antimalarial in stock, across survey round
Public Health Facility
2010
N=1,471
11%
Private Not For-Profit Facility
2011
N=1,348
3%
13%
3%
20%
31%
37%
Private For-Profit Facility
3%
2014
N=1,501
1% 3%
10%
12%
Registered Pharmacy
19%
Unregistered Pharmacy
21%
3%
General Retailer
33%
31%
Itinerant Drug Vendor
30%
12%
3%
The private sector accounted for more than 75% of antimalarial-stocking outlets at each survey round. However, the proportion of outlets accounted for by private for-profit health facilities
and registered pharmacies increased over time (15% in 2010 versus 33% in 2014) relative to the proportion accounted for by unregistered pharmacies and general retail outlets (68% in
2010 versus 53% in 2014).
Figure 3. Market composition: outlet type distribution, 2014, urban/rural
Among all outlets with at least one antimalarial in stock
Urban
N=1,029
1% 3%
9%
6%
Rural
N=472
17%
Private Not For-Profit Facility
3%
26%
40%
5%
Registered Pharmacy
General Retailer
Itinerant Drug Vendor
14%
41%
16%
18%
4%
In urban and rural areas, approximately half of antimalarial-stocking outlets are informal private sector outlets. However, in urban areas these are primarily unregistered pharmacies (41%)
while in rural areas general retailers accounted for 40% of all antimalarial-stocking outlets. One-quarter of antimalarial-stocking outlets in rural areas were public sector outlets as compared
with 10% in urban areas, where private for-profit health facilities (26%) and registered pharmacies (16%) were more common than in rural areas (private for-profit facilities, 14%; registered
pharmacies, 4%).
www.ACTwatch.info
Page 16
Figure 4. Percentage of outlets with at least one antimalarial in stock on the day of the survey, 20102014
Among all screened outlets, across survey round
100
Percentage of outlets
90
80
70
60
50
40
30
20
10
0
2010
2011
2014
Private-Not-For-Profit Facility
Private-For-Profit Facility
Registered Pharmacy
General Retailer
Availability of antimalarials in public health facilities, registered pharmacies and unregistered pharmacies remained high
(nearly 90% or higher) over time. However, 2014 shows a drop from 2011 levels in the availability of antimalarials in private
not for-profit and private for-profit facilities. For each of the surveys, the availability of antimalarials among CHWs has been
low (<5%).
Figure 5. Percentage of outlets with at least one antimalarial in stock on the day of the survey, 2014,
urban/rural
Among all screened outlets
100
90
80
70
60
50
40
30
20
10
0
Private For-Profit
Facility
Registered Pharmacy
Urban
Unregistered
Pharmacy
General Retailer
Rural
Antimalarial availability was similar across urban and rural locations among private health facilities, registered pharmacies and
unregistered pharmacies. Among public health facilities, 84% of all screened outlets in urban locations stocked antimalarials
compared with 99% in rural locations.
www.ACTwatch.info
Page 17
Figure 6. Percentage of antimalarial-stocking outlets with ACT in stock on the day of the survey, 20102014
100
90
80
70
60
50
40
30
20
10
0
2010
2011
General Retailer
2014
Registered Pharmacy
ACT availability declined among antimalarial-stocking public health facilities between 2011 (97%) and 2014 (84%) and
remained high among registered pharmacies over time (>90%). ACT availability among antimalarial-stock outlets increased
over time among private for-profit facilities (2010, 58%; 2011, 84%; 2014, 93%), unregistered pharmacies (2010, 47%; 2011,
90%; 2014, 92%) and general retailers (2010, 0%; 2011, 24%; 2014, 27%).
Figure 7. Percentage of antimalarial-stocking outlets with ACT in stock on the day of the survey, 2014,
urban/rural
100
90
80
70
60
50
40
30
20
10
0
Private For-Profit
Facility
Registered Pharmacy
Urban
Unregistered
Pharmacy
General Retailer
Rural
ACT availability was similar among antimalarial-stocking outlets in urban versus rural areas across outlet type.
www.ACTwatch.info
Page 18
Figure 8. Percentage of antimalarial-stocking outlets with quality-assured ACT in stock on the day of
the survey, 2010-2014
100
90
80
70
60
50
40
30
20
10
0
2010
2011
Privat For-Profit Facility
General Retailer
2014
Registered Pharmacy
QA ACT availability declined among antimalarial-stocking public health facilities between 2011 (97%) and 2014 (83%) and
remained high among registered pharmacies between 2010 and 2014 (around 90%). QA ACT availability among antimalarialstock outlets increased between 2010 and 2011 and increases were maintained in 2014 among private for-profit facilities
(2010, 37%; 2011, 78%; 2014, 84%), unregistered pharmacies (2010, 33%; 2011, 86%; 2014, 84%) and general retailers (2010,
0%; 2011, 23%; 2014, 26%).
Figure 9. Percentage of antimalarial-stocking outlets with quality-assured ACT in stock on the day of
the survey, 2014, urban/rural
100
90
80
70
60
50
40
30
20
10
0
Private For-Profit
Facility
Registered Pharmacy
Urban
Unregistered
Pharmacy
General Retailer
Rural
QA ACT availability was similar among antimalarial-stocking outlets in urban versus rural areas across outlet type.
www.ACTwatch.info
Page 19
Figure 10. Percentage of antimalarial-stocking outlets with quality-assured ACT marked with the
‘green leaf’ logo in stock on the day of the survey, 2010-2014
100
90
80
70
60
50
40
30
20
10
0
2010
2011
General Retailer
2014
Registered Pharmacy
The availability of co‐paid QA ACT marked with the ‘green leaf’ logo among antimalarial-stocking outlets decreased among
public health facilities between 2011 (69%) and 2014 (30%). However, availability remained high (>70%) between 2011 and
2014 among private for-profit health facilities, registered pharmacies and unregistered pharmacies. One-fifth of antimalarialstocking general retailers had QA ACT with the ‘green leaf’ logo in stock in 2011 (23%) and 2014 (21%).
Figure 11. Percentage of antimalarial-stocking outlets with quality-assured ACT marked with the
‘green leaf’ in stock on the day of the survey, 2014, urban/rural
100
90
80
70
60
50
40
30
20
10
0
Private For-Profit
Facility
Registered Pharmacy
Urban
Unregistered
Pharmacy
General Retailer
Rural
Availability of QA ACT with the ‘green leaf’ logo was similar among antimalarial-stocking outlets in urban versus rural areas
across outlet type.
www.ACTwatch.info
Page 20
Figure 12. Percentage of antimalarial-stocking outlets with non-quality-assured ACT in stock on the
day of the survey, 2010-2014
100
90
80
70
60
50
40
30
20
10
0
2010
2011
General Retailer
2014
Registered Pharmacy
The majority of antimalarial-stocking registered pharmacies had non-QA ACT in stock across survey rounds (>85%).
Availability has increased over time among unregistered pharmacies from 29% in 2010 to 50% in 2014. Public health facilities,
and general retailers generally did not have non-QA ACT in stock across survey rounds (<5%).
Figure 13. Percentage of antimalarial-stocking outlets with non-quality-assured ACT in stock on the day
of the survey, 2014, urban/rural
100
90
80
70
60
50
40
30
20
10
0
Private For-Profit Registered Pharmacy
Facility
Urban
Unregistered
Pharmacy
General Retailer
Rural
Non-quality-assured ACT availability is higher among antimalarial-stocking urban as compared with rural outlets across private
sector outlet types including private for-profit facilities (54% versus 33%), registered pharmacies (89% versus 69%),
unregistered pharmacies (54% versus 33%) and general retailers (6% versus 1%).
www.ACTwatch.info
Page 21
Figure 14. Types of quality-assured ACT and non-quality-assured ACT found among public and private
sector outlets, 2014
Among all ACT medicines audited, across sector, 2014
AL tablet
QA ACT Public
ASAQ tablet
N=979
ASMQ tablet
A PPQ tablet
AS SP tablet
DHA PPQ tablet
AN tablet
AL non-tablet
100%
ASMQ non-tablet
DHA PPQ non-tablet
QA ACT Private
N=2,245
Non-QA ACT
Public
N=62
14%
7%
32%
5%
Non-QA ACT
Private
N=3,093
19
%
22
%
0%
8%
95%
36%
7%
32%
4%
The majority of QA ACT products were audited in the private sector and all products audited in the public sector were AL
tablets. A variety of non-QA ACT products were audited in the public and private sector and the majority of these were tablet
formulations (>75%) including non-QA AL tablets (32% of public and 19% of private sector non-QA ACT) and non-QA DHA PPQ
tablets (36% of public and 32% of private sector non-QA ACT). Common manufacturers of non-QA AL and DHA PPQ included
Bliss GVS Pharmaceuticals (AL and DHA PPQ) and Beijing Holley-Cotec Pharmaceuticals (DHA PPQ).
www.ACTwatch.info
Page 22
Figure 15. Percentage of antimalarial-stocking outlets with non-artemisinin therapy in stock on the
day of the survey, 2010-2014
100
90
80
70
60
50
40
30
20
10
0
2010
2011
General Retailer
2014
Registered Pharmacy
The availability of non-artemisinin therapy among antimalarial-stocking outlets has generally decreased since 2010 among
public and private sector outlets. In 2014, availability was highest among general retailers (81%) and lowest among private
for-profit facilities (52%).
Figure 16. Percentage of antimalarial-stocking outlets with non-artemisinin therapy in stock on the day
of the survey, 2014, urban/rural
100
90
80
70
60
50
40
30
20
10
0
Private For-Profit
Facility
Registered Pharmacy
Urban
Unregistered
Pharmacy
General Retailer
Rural
Data trends suggest higher availability of non-artemisinin therapy among antimalarial-stocking outlets in rural versus urban areas
among public and private sector outlet types.
www.ACTwatch.info
Page 23
Figure 17. Percentage of antimalarial-stocking outlets with SP in stock on the day of the survey, 20102014
100
90
80
70
60
50
40
30
20
10
0
2010
2011
General Retailer
2014
Registered Pharmacy
SP is used for intermittent preventive treatment of malaria in pregnancy and should be dispensed during antenatal clinic visits. SP
availability among antimalarial‐stocking health facilities has declined in recent years including among public health facilities (2010,
75%; 2011, 57%; 2014, 15%) and private for-profit facilities (2010, 43%, 2011, 42%; 2014 25%). More than half of antimalarialstocking outlets had SP available in 2014 among registered pharmacies (53%), unregistered pharmacies (58%) and general retailers
(62%).
Figure 18. Percentage of antimalarial-stocking outlets with SP in stock on the day of the survey, 2014,
urban/rural
100
90
80
70
60
50
40
30
20
10
0
Private For-Profit Registered Pharmacy
Facility
Urban
Rural
Unregistered
Pharmacy
General Retailer
SP availability was similar among antimalarial-stocking public and private facilities and general retailers in urban versus rural
areas. Data trends suggest higher availability among registered pharmacies and unregistered pharmacies located in rural versus
urban areas.
www.ACTwatch.info
Page 24
Figure 19. Percentage of antimalarial-stocking outlets with SP in stock on the day of the survey, by
regions targeted or not targeted for IPTp, 2014
Among all outlets with at least one antimalarial in stock, 2014
100
90
80
70
60
50
40
30
20
10
0
Target Areas
Non-Target Areas
General Retailer
Registered Pharmacy
SP is used for intermittent preventive treatment of malaria in pregnancy and should be dispensed during antenatal clinic visits. In
keeping with the WHO guidelines published in 2012 to limit SP use for IPTp to malaria-endemic areas, Kenya has designated areas
for the use of SP for the purposes of IPTp to those where transmission is intense throughout the year, and P. falciparum prevalence
is historically greater than 20%. These areas include altitudes ranging from sea level in the coastal area to up to 1,300 meters
around the Lake Victoria basin.
SP availability among antimalarial‐stocking health facilities in target areas is higher on average than availability in non-target areas.
Half of the public health facilities in target areas had SP on-hand, compared to 2% of public health facilities in non-target areas.
Similarly, SP availability in registered pharmacies was also higher in target areas compared to non-target areas (70% compared to
50%). Availability among private-for-profit facilities (23% and 25%) and unregistered pharmacies (60% and 57%) was nearly the
same across target and non-target areas.
www.ACTwatch.info
Page 25
Figure 20. Percentage of antimalarial-stocking outlets with any severe malaria treatment in stock on
the day of the survey, 2010-2014
100
90
80
70
60
50
40
30
20
10
0
2010
2011
General Retailer
2014
Registered Pharmacy
Treatments for severe malaria include artesunate IV/IM, quinine IV/IM, artemether IV/IM, artemotil IV/IM, and artesunate
suppositories. Severe malaria treatment availability among antimalarial-stocking outlets has remained similar over time
among public health facilities (80% in 2014) and private for-profit health facilities (59% in 2014), and has declined between
2010 and 2014 among registered pharmacies (66%, 28%) and unregistered pharmacies (26%, 17%).
Figure 21. Percentage of antimalarial-stocking outlets with any severe malaria treatment in stock on
the day of the survey, 2014, urban/rural
100
90
80
70
60
50
40
30
20
10
0
Private For-Profit
Facility
Registered Pharmacy
Urban
Unregistered
Pharmacy
General Retailer
Rural
Severe malaria treatment availability was higher among antimalarial-stocking unregistered pharmacies in rural (28%) versus
urban areas (14%). Data trends suggest higher availability in rural versus urban registered pharmacies as well as urban versus
rural private for-profit health facilities.
www.ACTwatch.info
Page 26
Percentage of total market volume
Figure 22. Antimalarial market share, 2010-2014
Relative market volume (sale/distribution) of antimalarial AETDs, by sector and antimalarial
class, across survey round
100
90
80
70
60
50
40
30
20
10
0
Public
Private
Public
2010
Private
Public
2011
Private
2014
QAACT without 'green leaf'
QAACT with 'green leaf'
Non-QAACT
SP
Other non-artemisinin therapy
Oral artemisinin monotherapy
Non-oral artemisinin monotherapy
The antimalarial market share for the private sector has increased from 67% in 2010 and 63% in 2011 to 88% in 2014. QA ACT
market share has increased from 26% in 2010 to 57% in 2011 and 51% in 2014. QA ACT marked with the ‘green leaf’ logo
indicating co-payment accounted for half of all antimalarials distributed in 2011 dropping to 40% in 2014.
Percentage of sector market volume
Figure 23. Antimalarial market share within sector, 2010-2014
Relative market volume (sale/distribution) of antimalarial AETDs, within sector, by
antimalarial class, across survey round
100
80
60
40
20
0
Public
Private
2010
Public
Private
Public
2011
Private
2014
Non-QAACT
SP
Approximately half of antimalarials distributed by the public sector were QA ACT in 2010 (54%) and 2011 (49%), increasing to
77% in 2014. In the private sector, QA ACT market share increased from 12% in 2010 to 62% in 2011 and dropped to 48% in
2014 in the context of increasing market share for non-QA ACT (2010, 11%; 2011, 7%; 2014, 20%). QA ACT with the ‘green
leaf’ logo have accounted for the majority of QA ACT treatment distributed by the private sector over time and approximately
half of QA ACTs distributed in the public sector in 2014.
www.ACTwatch.info
Page 27
Figure 24. Antimalarial market share, 2014
Relative market volume (sale/distribution) of antimalarial AETDs, by outlet type and
antimalarial class
100
90
80
70
60
50
40
30
20
10
0
Public
Private
Private for-Profit
Health Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
Non-QAACT
SP
Private sector market share in 2014 (88%) is comprised of relative market share for unregistered pharmacies (31%),
registered pharmacies (41%), private for‐profit health facilities (12%), and general retailers (5%).
Figure 25. Antimalarial market share, 2014, urban/rural
Relative market volume (sale/distribution) of antimalarial AETDs, by sector and antimalarial
class
100
90
80
70
60
50
40
30
20
10
0
Public
Private
Public
Urban
Private
Rural
Non-QAACT
SP
The private sector distributed 92% of the antimalarials in urban locations as compared with 72% in rural locations. QA ACT
accounted for half of antimalarials distributed in urban areas (50%) compared to 60% in rural areas. ‘Green leaf’ co‐paid QA
ACT market share was higher in rural (40%) as compared with urban areas (11%). Non‐QA ACT accounted for 22% of
antimalarials distributed in urban areas, compared with 5% in rural areas.
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Page 28
Figure 26. Percentage of antimalarial-stocking outlets with malaria blood testing available, 2010-2014
Among all outlets with at least one antimalarial in stock on the day of the survey or within the
past three months, across survey round
100
90
80
70
60
50
40
30
20
10
0
2010
2011
2014
General Retailer
Registered Pharmacy
Blood testing availability has increased among antimalarial-stocking health facilities including public health facilities (2010, 46%;
2011, 55%; 2014, 94%) and private not-for-profit facilities (2010, 53%; 2011, 45%; 2014, 74%). Availability has remained low
over time among registered pharmacies (21% in 2014) and unregistered pharmacies (16% in 2014).
Figure 27. Percentage of antimalarial-stocking outlets with malaria blood testing available, 2014,
urban/rural
past three months
100
90
80
70
60
50
40
30
20
10
0
Urban
Registered Pharmacy
Rural
Data trends suggest higher availability of malaria blood testing (RDT or microscopy) among antimalarial-stocking outlets in
urban versus rural areas.
www.ACTwatch.info
Page 29
Figure 28. Percentage of antimalarial-stocking outlets with malaria microscopy available, 2010-2014
100
90
80
70
60
50
40
30
20
10
0
2010
2011
General Retailer
2014
Registered Pharmacy
Malaria microscopy availability has increased over time among antimalarial-stocking health facilities including public health
facilities (2010, 41%; 2011, 42%; 2014, 61%) and private for-profit facilities (2010, 49%; 2011, 40%; 2014, 61%). Malaria
microscopy is generally not available among registered pharmacies (8% in 2014) and unregistered pharmacies (6% in 2014).
Figure 29. Percentage of antimalarial-stocking outlets with malaria microscopy available, 2014,
urban/rural
past three months
100
90
80
70
60
50
40
30
20
10
0
Urban
Registered Pharmacy
Rural
Malaria microscopy was more commonly available among urban versus rural public health facilities (71% versus 54%) and
private for-profit health facilities (66% versus 45%).
www.ACTwatch.info
Page 30
Figure 30. Percentage of antimalarial-stocking outlets with malaria RDTs, 2010-2014
100
90
80
70
60
50
40
30
20
10
0
2010
2011
2014
General Retailer
Registered Pharmacy
Availability of malaria RDTs among antimalarial‐stocking outlets was less than 10% across all outlet types in 2010. By 2014,
availability had increased significantly among public health facilities (68%) but remained relatively low among private for-profit
facilities (29%), registered pharmacies (15%) and unregistered pharmacies (12%).
Figure 31. Percentage of antimalarial-stocking outlets with malaria RDTs, 2014, urban/rural
past three months, across urban and rural zones
100
90
80
70
60
50
40
30
20
10
0
Urban
Registered Pharmacy
Rural
RDT availability among antimalarial-stocking outlets was higher among public health facilities in rural (73%) versus urban areas
(62%). Among private sector outlet types, data trends suggest higher availability in urban versus rural areas.
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Page 31
Figure 32. Malaria blood testing market share, 2014
Relative market volume (sale/distribution) of malaria blood testing using mRDTs and
microscopy, by outlet type and type of test
100
90
80
70
60
50
40
30
20
10
0
Public
Private
Private for-Profit
Health Facility
Microscopy
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
RDT
More than half of all malaria blood tests were performed by public sector outlets (53%) and the majority of these tests were
performed using microscopy. Malaria RDTs accounted for less than one-third of all tests performed (25%). Private for-profit
facilities accounted for the majority of malaria blood testing performed by the private sector (42% of all tests performed).
Percentage of within outlet market
volume
Figure 33. Malaria RDT market share by manufacturer, across sector, 2014
Relative market volume (sale/distribution) of malaria RDTs by manufacturer, within the public
and private sector outlet types
100
90
80
70
60
50
40
30
20
10
0
Public
ACCESS BIO INC.
Private
STANDARD DIAGNOSTICS INC.
Private for-Profit
Health Facility
CTK BIOTECH INC.
Registered
Pharmacy
Pharmacy
Other
Drug Store
Unregistered
Pharmacy
Manufacturer not specified
Among RDTs performed within public sector outlets, the majority (99%) were manufactured by Access Bio Inc. (99%). Within
the private sector, Access Bio Inc. accounted for 64% of the market share followed by Standard Diagnostics (19%).
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Page 32
Figure 34. Private sector median price of antimalarial adult equivalent treatment dosages (AETD),
2010-2014
Among all SP and quality-assured ACT (tablet formulation only) available in the private
sector, in 2010 US dollars to account for inflation, across survey round
$10.00
$9.00
$8.00
2010 USD
$7.00
$6.00
$5.00
$5.25
$4.61
$4.61
$4.00
$2.30
$3.00
$2.00
$0.46
$1.00
$0.52
$1.75
$0.66
$0.46
$0.00
2010
2011
Non QAACT
2014
Quality-Assured ACT
SP
The median private sector price for one adult equivalent treatment dose (AETD) of QA ACT decreased between 2010 and 2011,
however, the price of QA ACT more than doubled between 2011 and 2014 and in 2014 remained more than 2.5 times more
expensive than SP. The price of SP has remained similar over time and the price of non-QA ACT has increased over time and in
2014 non-QA ACT (tablet formulation) is three times as expensive as QA ACT.
Figure 35. Private sector median price of QA ACT adult equivalent treatment dosages (AETD) with and
without the ‘green leaf’ logo, 2010-2014
Among all quality-assured ACT (tablet formulation only) available in the private sector, in 2010
US dollars to account for inflation, across survey round
$6.00
$5.00
2010 USD
$4.00
$3.45
$3.00
$1.75
$2.00
$1.58
$1.15
$1.00
$0.46
$0.58
$0.00
2010
QAACT without "green leaf"logo
2011
2014
QAACT with "green leaf"logo
The median private sector price for one AETD of QA ACT with the green leaf logo was similar to the price of QA ACT without
the logo in 2011 and 2014.
www.ACTwatch.info
Page 33
Figure 36. Private sector median price of SP and quality-assured ACT adult equivalent treatment
dosages (AETD) and pre-packaged pediatric quality-assured AL, 2014
Among all SP, QA ACT, and pre-packaged pediatric (treatment for a 2 year old child) QA AL
(tablet formulation only) available in the private sector, in 2014 US Dollars
$2.50
$2.00
Median price
$1.69
$1.50
$1.50
$1.35 $1.35
$1.20
$1.00
$0.56
$0.68
$0.56
$0.50
$0.56
$0.56 $0.56 $0.56 $0.56 $0.56
$0.34
$0.00
SP AETD
QA ACT AETD
Registered Pharmacy
Pediatric QA AL
General Retailer
All private
The private sector median price for AL pre-packaged for a two-year old child was $0.56 across all private sector outlet types.
The median price of one QA ACT AETD was $1.50 in the private sector, ranging from a median of $1.13 among general retailers
to $1.69 among private for-profit health facilities. Similarly the price of SP was least expensive among general retailers ($0.34)
in comparison with registered pharmacies ($0.68).
Figure 37. Private sector median price of SP and quality-assured ACT adult equivalent treatment
dosages (AETD) and pre-packaged pediatric quality-assured AL, 2014, urban/rural
Among all SP, QA ACT, and pre-packaged pediatric (treatment for a 2 year old child) QA AL
(tablet formulation only) available in the private sector, in 2014 US Dollars
$3.00
Median price
$2.50
$2.00
$1.69
$1.50
$1.00
$1.13
$0.56
$0.56
$0.39
$0.56
$0.50
$0.00
SP AETD
QA ACT AETD
Urban
Pediatric QA AL
Rural
The private sector median price for QA AL pre-packaged for a two-year old child was the same in urban and rural areas ($0.56).
AETD median prices for SP and QA ACT were higher in urban versus rural areas.
www.ACTwatch.info
Page 34
Figure 38. Median private sector consumer prices for malaria RDT testing for adults and children 2014
Among all RDTs available within private for-profit health facilities, pharmacies and
unregistered pharmacies, inclusive of consultation and service fees, in 2014 US dollars
$3.00
$2.50
Median price
$2.00
$1.50
$1.13
$1.13
$1.13
$1.13
$1.13
$1.13
$1.13
$1.13
$1.00
$0.50
$0.00
RDT - Adult
Private-For-Profit Health Facility
RDT - Child
Registered Pharmacy
All Private
The median private sector price for malaria blood testing with an RDT, inclusive of service and consultation fees, was $1.13
across all private sector outlet types for both adults and children under five. The median price for blood testing with malaria
microscopy was also $1.13 across outlet types (data not shown).
www.ACTwatch.info
Page 35
Figure 39. Percentage of providers who correctly state the first-line treatment for uncomplicated
malaria, 2010-2014
Among providers in outlets with at least one antimalarial in stock on the day of the survey or
within the past three months, across survey round
100
90
80
70
60
50
40
30
20
10
0
2010
2011
General Retailer
2014
Registered Pharmacy
Across survey rounds, more than 90% of providers among antimalarial‐stocking public health facilities and registered
pharmacies correctly stated the first‐line treatment for uncomplicated malaria (AL). Knowledge of first line treatment increased
over time among providers at private for-profit health facilities (93% in 2014), unregistered pharmacies (91% in 2014) and
among general retailers (29%).
Figure 40. Percentage of providers who correctly state the first-line treatment for uncomplicated
malaria, 2014, urban/rural
within the past three months
100
90
80
70
60
50
40
30
20
10
0
Private For-Profit
Facility
Registered Pharmacy
Urban
Unregistered
Pharmacy
General Retailer
Rural
First-line treatment knowledge was similar among providers in urban versus rural areas across outlet type.
www.ACTwatch.info
Page 36
Figure 41. Percentage of providers who correctly state the first-line dosing regimen for uncomplicated
malaria for a two-year old child, 2010-2014
within the past three months, across survey round
100
90
80
70
60
50
40
30
20
10
0
2010
2011
General Retailer
2014
Registered Pharmacy
Overall, the percentage of providers who correctly state the first-line dosing regimen for uncomplicated malaria for a two-year
old child rose across the survey rounds. It also rose within outlet types with the exception of registered pharmacies where it
fell from 69% in 2010 to 64% in 2011.
Figure 42. Percentage of providers who correctly state the first-line dosing regimen for uncomplicated
malaria for a two-year old child, 2014, urban/rural
within the past three months
100
90
80
70
60
50
40
30
20
10
0
Private For-Profit
Facility
Registered Pharmacy
Urban
Unregistered
Pharmacy
General Retailer
Rural
Knowledge of the dosing regimen for a two-year old child using the first-line treatment for uncomplicated malaria was similar
among providers in urban versus rural areas across outlet type.
www.ACTwatch.info
Page 37
Results Section A: Core Indicators
Table A1: Availability of antimalarials, among all screened outlets, by outlet type
Community
Health Worker
Private NotFor-Profit
Health Facility
ALL
Public
%
(95% CI)
%
(95% CI)
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
N=485
N=553
N=58
N=1,096
92.5
(89.5, 94.7)
77.2
(72.7, 81.2)
77.2
(72.7, 81.2)
0.3
(0.1, 0.9)
0.0
1.9
(1.3, 3.0)
77.1
(72.6, 81.1)
77.1
(72.6, 81.1)
27.5
(22.1, 33.7)
64.6
(58.8, 69.9)
65.3
(59.7, 70.4)
39.5
(33.1, 46.2)
2.5
(1.7, 3.5)
75.8
(70.9, 80.2)
69.8
(64.2, 74.9)
2.6
(1.3, 5.0)
2.1
(0.9, 4.5)
2.1
(0.9, 4.5)
0.0
0.0
0.0
2.1
(0.9, 4.5)
2.1
(0.9, 4.5)
0.8
(0.4, 1.8)
1.5
(0.5, 4.3)
1.1
(0.4, 3.3)
1.8
(0.8, 4.3)
0.0
2.1
(0.9, 4.5)
0.5
(0.2, 1.2)
78.2
(68.7, 85.5)
75.6
(65.6, 83.5)
75.6
(65.6, 83.5)
0.0
0.0
18.2
(11.5, 27.5)
75.6
(65.6, 83.5)
75.6
(65.6, 83.5)
51.1
(36.5, 65.5)
43.2
(27.2, 60.7)
43.8
(28.2, 60.7)
63.2
(48.7, 75.6)
33.5
(18.6, 52.6)
73.0
(63.0, 81.2)
52.3
(37.9, 66.3)
18.6
(14.2, 24.0)
16.2
(12.2, 21.1)
16.2
(12.2, 21.1)
0.0
(0.0, 0.1)
0.0
1.5
(1.0, 2.3)
16.1
(12.2, 21.1)
16.1
(12.2, 21.1)
7.5
(5.1, 10.8)
12.0
(8.8, 16.0)
11.8
(8.6, 15.9)
10.6
(7.4, 14.9)
2.6
(1.3, 5.2)
15.8
(11.9, 20.6)
12.4
(9.3, 16.5)
Public
Health
Facility
%
(95% CI)
Proportion of outlets*
stocking:
Any antimalarial at the
time of survey visit
Any ACT
Artemether
Lumefantrine (AL) 
Artesunate Sulfadoxine
Pyrimethamine (ASSP)
Artesunate Amodiaquine
(ASAQ)
DHA PPQ
Quality Assured ACT (QA
ACT)
QA AL
QA ACT with the
‘green leaf’ logo
QA ACT without the
QA ACT – child (<5
years)
QA ACT – adult
Non-quality-assured ACT
(non-QA ACT)
Nationally Registered
ACT
Any non-artemisinin
therapy
Registered
Pharmacy
Unregistered
Pharmacy
General
Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
N=453
N=503
N=572
N=9,950
N=11,580
N=12,676
73.3
(68.5, 77.6)
67.9
(63.6, 71.8)
66.4
(62.2, 70.3)
2.1
(1.3, 3.3)
4.5
(3.2, 6.3)
22.9
(19.7, 26.5)
61.2
(57.2, 65.2)
60.6
(56.7, 64.4)
53.9
(50.0, 57.7)
14.9
(12.3, 18.1)
26.8
(23.6, 30.3)
50.0
(45.3, 54.7)
36.2
(33.0, 39.6)
65.6
(61.7, 69.2)
38.3
(33.8, 43.0)
96.3
(94.2, 97.7)
96.2
(94.1, 97.5)
94.2
(91.7, 96.0)
12.2
(8.8, 16.8)
16.5
(13.6, 19.9)
73.2
(67.1, 78.5)
87.1
(84.8, 89.1)
85.5
(83.1, 87.6)
82.7
(80.5, 84.8)
17.2
(14.4, 20.2)
44.0
(40.6, 47.5)
77.6
(74.8, 80.1)
84.4
(79.9, 88.1)
94.5
(92.4, 96.0)
62.0
(57.9, 65.9)
93.2
(91.7, 94.4)
85.8
(82.9, 88.3)
83.9
(81.1, 86.3)
3.8
(2.3, 6.3)
6.1
(4.8, 7.8)
34.2
(28.7, 40.3)
78.5
(76.0, 80.8)
77.9
(75.4, 80.2)
71.0
(67.5, 74.2)
16.3
(14.1, 18.8)
34.5
(31.0, 38.3)
66.7
(63.6, 69.7)
46.7
(40.3, 53.1)
83.0
(80.3, 85.4)
65.6
(62.2, 68.8)
2.9
(2.1, 4.0)
0.8
(0.4, 1.4)
0.8
(0.4, 1.4)
0.0
(0.0, 0.1)
0.0
0.1
(0.0, 0.1)
0.8
(0.4, 1.3)
0.8
(0.4, 1.3)
0.6
(0.4, 1.1)
0.2
(0.1, 0.4)
0.3
(0.2, 0.6)
0.5
(0.3, 0.9)
0.1
(0.0, 0.1)
0.8
(0.4, 1.3)
2.3
(1.6, 3.4)
10.7
(9.8, 11.7)
8.3
(7.3, 9.3)
8.1
(7.2, 9.1)
0.4
(0.3, 0.6)
0.6
(0.5, 0.8)
3.3
(2.8, 3.8)
7.5
(6.7, 8.5)
7.5
(6.7, 8.4)
6.7
(6.0, 7.6)
1.6
(1.4, 1.9)
3.4
(2.9, 3.9)
6.3
(5.5, 7.1)
4.5
(3.8, 5.2)
8.0
(7.1, 9.0)
7.2
(6.5, 8.1)
11.3
(10.4, 12.3)
8.8
(7.9, 9.8)
8.7
(7.8, 9.7)
0.4
(0.3, 0.6)
0.6
(0.5, 0.7)
3.1
(2.6, 3.7)
8.2
(7.4, 9.1)
8.1
(7.3, 9.0)
6.8
(6.0, 7.7)
2.4
(2.1, 2.8)
4.0
(3.5, 4.5)
6.6
(5.8, 7.4)
4.3
(3.7, 5.1)
8.6
(7.7, 9.5)
7.6
(6.9, 8.5)
www.ACTwatch.info
Page 38
Table A1: Availability of antimalarials, among all screened outlets, by outlet type
stocking:
SulfadoxinePyrimethamine
Oral Quinine
Quinine IV/IM
Other non-artemisinin
therapy
Oral artemisinin
monotherapy
Non-oral artemisinin
monotherapy
Injectable artemether
Injectable artesunate
Injectable artemotil
Any treatment for severe
malaria
Public
Health
Facility
Community
Health Worker
Health Facility
ALL
Public
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General
Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
N=485
N=553
N=58
N=1,096
N=453
N=503
N=572
N=9,950
N=11,580
N=12,676
13.9
(9.7, 19.6)
41.5
(36.1, 47.2)
54.2
(48.2, 60.1)
0.9
(0.4, 1.9)
0.0
50.8
(45.6, 56.0)
4.0
(2.6, 6.0)
49.6
(44.3, 54.9)
0.0
74.2
(69.5, 78.4)
0.5
(0.2, 1.2)
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
-
13.9
(8.0, 23.0)
33.5
(19.1, 51.9)
41.9
(26.1, 59.5)
1.9
(0.3, 10.2)
0.0
48.4
(35.0, 62.0)
42.2
(28.3, 57.5)
11.2
(6.7, 18.2)
0.0
61.2
(48.2, 72.7)
3.1
(2.2, 4.2)
7.3
(5.1, 10.3)
9.4
(6.8, 12.8)
0.2
(0.1, 0.7)
0.0
9.4
(6.8, 12.9)
3.4
(1.8, 6.2)
6.7
(5.0, 9.0)
0.0
13.1
(9.9, 17.3)
18.1
(15.7, 20.8)
12.0
(9.6, 14.9)
22.7
(19.5, 26.2)
3.9
(2.5, 5.9)
0.1
(0.0, 0.3)
32.2
(29.0, 35.5)
28.2
(25.2, 31.4)
6.6
(5.1, 8.6)
1.5
(0.9, 2.3)
43.7
(40.3, 47.1)
50.8
(47.5, 54.1)
20.2
(16.5, 24.5)
11.2
(8.6, 14.3)
14.2
(12.0, 16.7)
0.0
24.3
(20.0, 29.2)
23.9
(19.5, 28.8)
4.3
(2.6, 7.0)
5.2
(3.2, 8.5)
26.8
(22.3, 31.9)
53.6
(50.1, 56.9)
24.6
(20.2, 29.5)
10.9
(7.6, 15.2)
8.4
(6.7, 10.6)
0.0
8.7
(6.6, 11.3)
8.6
(6.6, 11.1)
1.2
(0.6, 2.6)
0.9
(0.5, 1.6)
15.6
(12.1, 19.9)
1.8
(1.2, 2.6)
0.1
(0.0, 0.4)
0.0
(0.0, 0.1)
0.5
(0.2, 1.4)
0.0
0.0
(0.0, 0.1)
0.0
(0.0, 0.1)
0.0
0.0
0.0
(0.0, 0.1)
5.3
(4.7, 6.0)
1.9
(1.6, 2.2)
1.5
(1.3, 1.8)
1.1
(0.8, 1.7)
0.0
1.9
(1.6, 2.2)
1.7
(1.5, 2.0)
0.4
(0.3, 0.5)
0.2
(0.1, 0.2)
2.7
(2.4, 3.1)
5.1
(4.6, 5.8)
2.3
(2.0, 2.7)
2.1
(1.8, 2.4)
1.1
(0.7, 1.6)
0.0
2.5
(2.2, 2.8)
1.9
(1.6, 2.2)
0.8
(0.7, 1.0)
0.1
(0.1, 0.2)
3.5
(3.1, 3.8)
 At the time of the 2014 Kenya ACTwatch outlet survey, artemether lumefantrine was the first-line treatment for uncomplicated malaria.
www.ACTwatch.info
Page 39
Table A2: Availability of antimalarials, among outlets stocking at least one antimalarial, by outlet type
stocking:
Any ACT
Artemether Lumefantrine
(AL) 
(ASAQ)
DHA PPQ
ACT)
QA AL
QA ACT with the ‘green
leaf’ logo
QA ACT without the
QA ACT – child (<5
years)
QA ACT – adult
(non-QA ACT)
Nationally Registered ACT
Any non-artemisinin
therapy
SulfadoxinePyrimethamine
Oral Quinine
Quinine IV/IM
Public
Health
Facility
%
(95% CI)
Private Not-ForProfit Health
Facility
ALL
Public 1
%
(95% CI)
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
N=457
N=43
N=517
83.5
(79.6, 86.8)
83.5
(79.6, 86.8)
0.3
(0.1, 1.0)
0.0
2.1
(1.4, 3.2)
83.4
(79.5, 86.6)
83.4
(79.5, 86.6)
29.8
(24.0, 36.3)
69.8
(64.0, 75.0)
70.6
(65.2, 75.4)
42.7
(36.0, 49.6)
2.7
(1.9, 3.8)
82.0
(77.4, 85.8)
75.5
(70.1, 80.2)
15.0
(10.5, 21.1)
44.9
(39.0, 50.9)
58.6
(52.6, 64.5)
96.7
(93.1, 98.5)
96.7
(93.1, 98.5)
0.0
0.0
23.2
(13.8, 36.4)
96.7
(93.1, 98.5)
96.7
(93.1, 98.5)
65.3
(47.1, 80.0)
55.2
(37.1, 72.0)
56.0
(38.3, 72.3)
80.8
(61.1, 91.8)
42.8
(24.3, 63.6)
93.4
(87.8, 96.5)
66.8
(52.0, 79.0)
17.8
(10.2, 29.3)
42.8
(25.7, 61.8)
53.6
(35.8, 70.5)
86.8
(83.2, 89.8)
86.8
(83.2, 89.8)
0.2
(0.1, 0.6)
0.0
8.0
(5.6, 11.2)
86.8
(83.1, 89.7)
86.8
(83.1, 89.7)
40.2
(33.5, 47.3)
64.2
(56.7, 71.2)
63.4
(56.7, 69.5)
56.9
(48.1, 65.2)
14.0
(7.9, 23.5)
85.0
(80.8, 88.4)
66.8
(59.4, 73.4)
16.5
(12.6, 21.3)
39.2
(31.9, 47.0)
50.5
(42.8, 58.2)
Registered
Pharmacy
Unregistered
Pharmacy
General
Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
N=342
N=487
N=535
N=252
N=1,616
N=2,133
92.6
(90.4, 94.3)
90.5
(88.4, 92.3)
2.8
(1.7, 4.7)
6.2
(4.6, 8.3)
31.3
(26.2, 36.9)
83.6
(80.7, 86.1)
82.7
(79.7, 85.3)
73.5
(69.1, 77.4)
20.4
(17.2, 23.9)
36.6
(32.2, 41.2)
68.2
(64.7, 71.6)
49.4
(44.8, 54.0)
89.4
(87.2, 91.3)
52.3
(47.5, 57.0)
24.7
(21.7, 28.0)
16.3
(13.3, 19.8)
30.9
(26.9, 35.3)
99.9
(99.7, 99.9)
97.8
(96.8, 98.5)
12.7
(9.1, 17.4)
17.2
(14.3, 20.4)
76.0
(70.6, 80.7)
90.5
(88.8, 92.0)
88.8
(87.0, 90.4)
85.9
(83.9, 87.7)
17.8
(15.1, 20.8)
45.7
(42.3, 49.2)
80.6
(78.4, 82.5)
87.7
(84.2, 90.5)
98.1
(96.9, 98.8)
64.3
(60.6, 67.9)
52.8
(49.4, 56.2)
21.0
(17.3, 25.2)
11.6
(9.0, 14.8)
92.1
(89.0, 94.3)
90.0
(87.1, 92.3)
4.1
(2.5, 6.8)
6.6
(5.1, 8.4)
36.7
(30.7, 43.3)
84.2
(81.8, 86.3)
83.6
(81.2, 85.8)
76.1
(72.6, 79.4)
17.5
(15.1, 20.2)
37.0
(33.3, 40.9)
71.6
(68.3, 74.7)
50.1
(43.2, 57.0)
89.0
(86.2, 91.4)
70.3
(66.9, 73.6)
57.5
(54.0, 60.8)
26.4
(21.7, 31.7)
11.7
(8.2, 16.4)
27.0
(15.7, 42.5)
27.0
(15.7, 42.5)
1.6
(0.5, 4.8)
0.0
2.0
(0.7, 5.2)
26.2
(15.1, 41.6)
26.2
(15.1, 41.6)
21.4
(12.9, 33.4)
5.5
(2.2, 13.3)
11.2
(5.8, 20.5)
18.9
(11.3, 29.7)
2.0
(0.7, 5.2)
26.0
(15.1, 41.0)
80.9
(68.6, 89.1)
62.0
(48.0, 74.3)
4.0
(1.1, 13.1)
0.4
(0.1, 2.1)
77.1
(69.8, 83.1)
75.6
(68.5, 81.4)
3.9
(2.8, 5.6)
5.8
(4.8, 7.1)
30.4
(25.8, 35.4)
70.5
(64.4, 76.0)
69.9
(63.8, 75.4)
63.0
(57.6, 68.2)
15.4
(13.3, 17.8)
31.4
(27.7, 35.4)
58.7
(53.5, 63.8)
41.6
(36.0, 47.5)
74.7
(67.8, 80.5)
67.6
(63.4, 71.6)
49.6
(45.5, 53.6)
17.8
(15.5, 20.4)
14.0
(11.7, 16.5)
78.3
(71.8, 83.7)
76.9
(70.6, 82.2)
3.5
(2.5, 4.9)
5.1
(4.2, 6.3)
27.7
(23.5, 32.3)
72.5
(66.9, 77.5)
72.0
(66.4, 76.9)
60.3
(55.5, 64.9)
21.3
(18.5, 24.5)
35.3
(31.5, 39.3)
58.5
(53.6, 63.2)
38.3
(33.1, 43.7)
75.9
(69.8, 81.1)
67.5
(63.7, 71.1)
45.6
(41.9, 49.3)
20.4
(17.8, 23.3)
18.4
(15.8, 21.4)
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Page 40
Table A2: Availability of antimalarials, among outlets stocking at least one antimalarial, by outlet type
stocking:
therapy
Oral artemisinin
monotherapy
monotherapy
malaria
1
Public
Health
Facility
%
(95% CI)
Private Not-ForProfit Health
Facility
ALL
Public 1
%
(95% CI)
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
N=457
N=43
N=517
0.9
(0.4, 2.0)
0.0
54.9
(49.0, 60.7)
4.3
(2.8, 6.5)
53.6
(47.7, 59.5)
0.0
80.2
(75.6, 84.1)
.42
(0.4, 12.9)
0.0
61.9
(46.9, 74.9)
54.0
(37.8, 69.3)
14.4
(8.3, 23.6)
0.0
78.2
(65.3, 87.2)
1.2
(0.4, 3.4)
0.0
50.7
(43.9, 57.6)
18.2
(11.2, 28.1)
36.2
(29.8, 43.2)
0.0
70.6
(63.2, 77.0)
Registered
Pharmacy
Unregistered
Pharmacy
General
Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
N=342
N=487
N=535
N=252
N=1,616
N=2,133
5.3
(3.5, 7.8)
0.2
(0.1, 0.4)
43.9
(39.8, 48.1)
38.4
(34.9, 42.1)
9.0
(6.9, 11.8)
2.0
(1.3, 3.3)
59.6
(55.3, 63.7)
14.7
(12.5, 17.3)
0.0
25.3
(21.1, 30.0)
24.8
(20.5, 29.6)
4.4
(2.7, 7.2)
5.4
(3.3, 8.8)
27.9
(23.5, 32.7)
9.1
(7.2, 11.3)
0.0
9.3
(7.1, 12.2)
9.2
(7.0, 11.9)
1.3
(0.6, 2.8)
1.0
(0.6, 1.7)
16.8
(13.0, 21.4)
17.9
(7.3, 37.6)
0.0
0.8
(0.3, 2.4)
0.8
(0.3, 2.4)
0.0
0.0
1.2
(0.4, 3.1)
10.7
(7.2, 15.7)
0.0
(0.0, 0.1)
17.8
(15.3, 20.6)
16.2
(14.0, 18.8)
3.3
(2.4, 4.5)
1.4
(0.9, 2.2)
25.2
(22.1, 28.6)
9.6
(6.4, 14.0)
0.0
(0.0, 0.1)
21.8
(19.3, 24.5)
16.5
(14.3, 18.9)
7.3
(6.1, 8.7)
1.3
(0.8, 1.9)
30.7
(27.5, 34.2)
This includes 17 CHWs
* Antimalarial-stocking outlets have at least one antimalarial in stock on the day of the survey, verified by presence of at least one antimalarial recorded in the antimalarial audit sheet. There were 67
antimalarial stocking outlets with partially completed interviews. The denominator includes only completed interviews.
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Page 41
Table A3: Antimalarial market composition
Outlet type, among outlets with at least 1
antimalarial in stock on the day of the
survey:*
N=1,501 outlets
Public
Health
Facility
Community
Health Worker
Facility
ALL
Public
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General
Retailer
ALL
Private
%
%
%
%
%
%
%
%
%
9.5
1.3
3.3
14.0
21.4
11.8
33.0
19.8
86.0
(7.9, 11.4)
(0.6, 2.5)
(2.3, 4.7)
(11.7, 16.8)
(19.3, 23.6)
(8.6, 16.0)
(28.3, 38.0)
(14.5, 26.4)
(83.2, 88.3)
* Excluding booster sample outlets. Outlets with at least one antimalarial in stock on the day of the survey, verified by presence of at least one antimalarial recorded in the antimalarial audit sheet.
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Page 42
Table A4a: Price of tablet formulation antimalarials, by outlet type
Private
For-Profit
Facility
Median price of a tablet AETD*:
Any ACT
Artemether Lumefantrine (AL) 
Artesunate sulfadoxine pyrimethamine
(ASSP)
DHA PPQ
Quality assured ACT (QA ACT)
QA ACT with ‘green leaf’ logo
QA ACT without the ‘green leaf’ logo
QA AL
Non-quality-assured ACT (non-QA ACT)
Sulfadoxine-Pyrimethamine
Quinine
Registered Pharmacy
General Retailer
ALL
Private
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
(N of Antimalarials)
$2.25
$3.38
$2.25
$1.69
$2.25
[1.35-4.51]
(655)
[1.58-5.63]
(2,115)
[1.20-4.51]
(1,432)
[1.13-3.38]
(84)
[1.35-4.51] (4,286)
$1.69
$1.69
$1.69
$1.35
$1.69
[1.13-3.15] (476)
[1.13-2.82] (1,116)
[1.13-2.25] (961)
[1.13-1.69] (73)
[1.13-2.25] (2,626)
$5.63
$5.63
$5.07
$9.91
$5.63
[5.07-6.20]
(12)
[5.07-6.08]
(76)
[4.51-7.88]
(19)
[8.56-11.26]
(2)
[5.07-7.88] (109)
$3.94
$4.28
$4.51
$5.07
$4.51
[3.38-5.07] (115)
[3.38-5.63] (569)
[3.94-5.63] (291)
[3.38-5.63] (6)
[3.38-5.63] (981)
$1.69
$1.35
$1.35
$1.20
$1.50
[1.13-2.25]
(433)
$1.69
[1.13-2.25]
[1.13-1.80]
(889)
$1.35
(360)
[1.13-1.80]
(818)
$1.35
[1.13-1.80]
(784)
[1.13-1.80]
[1.13-1.69]
(69)
$1.13
(725)
[1.13-1.69]
[1.13-2.25] (2,209)
$1.50
(61)
[1.13-2.25] (1,930)
$1.69
$1.20
$1.35
$1.69
$1.35
[1.13-2.25] (71)
[1.13-1.80] (105)
[1.13-1.69] (92)
[1.13-1.69] (8)
[1.13-1.69] (276)
$1.69
$1.35
$1.35
$1.20
$1.50
[1.13-2.25]
(410)
$4.51
[3.38-5.63]
[1.13-1.80]
(809)
$4.82
(222)
[3.38-9.08]
[1.13-1.80]
(781)
$4.51
(1,226)
[3.49-7.88]
[1.13-1.69]
(69)
$5.63
(614)
[3.38-11.26]
[1.13-2.25] (2,069)
$4.51
(15)
[3.38-7.21] (2,077)
$0.56
$0.68
$0.56
$0.34
$0.56
[0.45-1.13] (97)
[0.56-1.69] (480)
[0.56-1.13] (481)
[0.34-0.45] (195)
[0.39-0.90] (1,253)
$4.73
$3.78
$4.26
$1.14
$4.26
(1)
[2.37-4.73] (95)
[2.37-7.10]
(13)
[3.31-4.73]
(51)
[2.37-4.73]
(30)
* AETD - adult equivalent treatment dose - is or the number of milligrams required to treat a 60kg adult (see Annex 11). Information provided by the respondent about price for a specific amount of
antimalarial drug (e.g. price per tablet or price per specific package size) was converted to the price per AETD.
Figures in this table are derived using audited products with price information. The numbers of antimalarials captured in audit sheets with missing price information are as follows:
73 any ACT tablets, 47 artemether lumefantrine tablets, 2 artesunate sulfadoxine pyrimethamine tablets, 46 QA ACT tablets, 41 QA ACT AL tablets, 27 non-QA ACT tablets, 7 sulfadoxine
pyrimethamine tablets, 1 quinine tablet.
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Page 43
Table A4b: Price of pre-packaged antimalarials, by outlet type
Private
For-Profit
Facility
Median price of
one pre-packaged
therapy:
Adult QA AL
Pediatric QA AL *
Registered Pharmacy
ALL
Private
General Retailer
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
$1.58
$1.13
$1.13
$1.13
$1.13
[1.13-1.69]
(240)
[1.13-1.69]
(452)
[1.13-1.69]
(460)
[1.13-1.69]
(42)
[1.13-1.69] (1,194)
$0.56
$0.56
$0.56
$0.56
$0.56
[0.56-1.13] (65)
[0.45-0.90] (161)
[0.56-0.79] (131)
[0.56-1.13] (6)
[0.56-1.13] (363)
* Pediatric QA AL is the pre-packaged regimen appropriate for a 2 year old child.
27 adult QA AL, 5 child QA AL.
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Page 44
Table A5: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type
Proportion of
outlets*** stocking
Any malaria blood
testing
Microscopic blood
tests
Rapid diagnostic
tests (RDTs)
Checkmark RDTs
1
Public
Health
Facility
%
(95% CI)
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
N=471
N=573
94.0
ALL
Public1
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
N=375
N=490
N=556
N=405
N=1,826
N=2,399
73.0
74.3
21.0
16.1
0.0
25.2
31.6
(90.1, 96.4)
N=470
(53.0, 86.7)
N=571
(70.1, 78.0)
N=375
(18.0, 24.3)
N=490
(13.1, 19.7)
N=555
N=403
(21.3, 29.5)
N=1,823
(28.0, 35.4)
N=2,394
60.9
47.3
61.1
8.2
5.7
0.0
17.4
21.5
(56.8, 64.9)
N=470
(33.5, 61.6)
N=571
(56.7, 65.4)
N=375
(6.5, 10.4)
N=490
(4.1, 7.7)
N=555
N=403
(14.8, 20.5)
N=1,823
(18.7, 24.4)
N=2,394
68.2
51.7
29.2
15.0
12.3
0.0
12.6
17.8
(62.7, 73.3)
N=469
(39.7, 63.5)
N=570
(25.7, 33.0)
N=374
(11.8, 18.9)
N=490
(10.2, 14.8)
N=555
N=403
(10.5, 15.0)
N=1,822
(15.7, 20.1)
N=2,392
0.1
0.3
0.5
1.3
0.0
0.0
0.2
0.2
(0.0, 0.2)
(0.1, 1.3)
(0.2, 1.1)
(0.6, 3.1)
-
-
(0.1, 0.4)
(0.1, 0.4)
This includes 52 CHWs and 50 Private not-For-Profit outlets
* Blood testing availability is reported among outlets that either had antimalarials in stock on the day of the survey or reportedly stocked antimalarials in the previous 3 months.
*** Results in this table are derived using responses captured among outlets with blood testing information. There were 6 antimalarial-stocking outlets that had missing information about both
availability of microscopy and availability of RDTs. There were 18 antimalarial-stocking outlets that had partial information about blood testing availability.
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Page 45
Table A6: Malaria blood testing market composition
Outlet type, among outlets with malaria
blood testing available on the day of the
survey:*
N=631 outlets
Public
Health
Facility
Community
Health Worker
Facility
ALL
Public
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General
Retailer
ALL
Private
%
%
%
%
%
%
%
%
%
22.4
4.5
8.0
34.9
47.2
4.6
13.3
-
65.1
(18.7, 26.6)
(2.1, 9.1)
(5.5, 11.4)
(29.7, 40.4)
(43.0, 51.4)
(3.4, 6.2)
(10.4, 16.9)
-
(59.6, 70.3)
* Excluding booster sample outlets. Outlets with malaria blood testing available on the day of the survey, verified by presence of at least one RDT recorded in the RDT audit sheet and/or reported availability of
malaria microscopy.
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Page 46
Table A7: Price of malaria blood testing, by outlet type
Private
For-Profit
Facility
Total median price to
consumers:*
Registered Pharmacy
ALL
Private
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
Microscopic blood
tests
Adult
Child under age
five
$1.13
$1.13
$1.13
$1.13
[0.56-1.13] (263)
[1.13-1.13] (55)
[1.13-1.13] (30)
[0.56-1.13] (348)
$1.13
$1.13
$1.13
$1.13
[0.56-1.13] (263)
[1.13-1.13] (55)
[1.13-1.13] (30)
[0.56-1.13] (348)
Rapid diagnostic
tests (RDTs)
Adult
Child under five
$1.13
$1.13
$1.13
$1.13
[1.13-1.69] (134)
[1.13-1.13] (55)
[1.13-1.69] (59)
[1.13-1.69] (248)
$1.13
$1.13
$1.13
$1.13
[1.13-1.69] (133)
[1.13-1.13] (53)
[1.13-1.13] (59)
[1.13-1.69] (245)
Median price
excluding fees:**
Rapid diagnostic
tests (RDTs)
Adult
Child under five
$0.17
$0.90
$0.68
$0.68
(1)
[0.56-1.69] (13)
[0.56-1.13] (21)
[0.56-1.13] (35)
$0.17
$0.68
$0.68
$0.68
(1)
[0.56-1.69]
(12)
[0.56-1.13]
(21)
[0.56-1.13] (34)
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Page 47
Table A8: Antimalarial market share
AETDs sold or distributed in the previous
week by outlet type and antimalarial type
as a percentage of all AETDs sold /
distributed:*
1. Any ACT
Artemether Lumefantrine (AL)

Public
Health
Facility
TOTAL
Public
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
TOTAL
Private
ANTI-MALARIAL
TOTAL***
%
%
%
%
%
%
%
%
7.5
10.0
9.6
27.4
20.8
2.3
60.0
70.0
21.0
17.8
2.1
49.2
58.8
7.4
9.6
8.3
DHA PPQ
0.0
0.4
0.8
4.8
2.2
0.2
7.9
8.3
Quality Assured ACT (QA ACT)
7.4
9.4
6.9
17.4
16.3
1.8
42.3
51.7
QA ACT with the ‘green leaf’ logo
3.8
4.8
5.5
14.1
14.1
1.4
35.1
39.9
3.6
4.6
1.4
3.2
2.2
0.4
7.2
11.8
0.1
0.6
2.7
10.0
4.5
0.5
17.7
18.3
7.2
9.6
8.7
21.7
18.1
2.0
50.5
60.0
2. Any non-artemisinin therapy
1.8
2.1
1.8
12.6
9.5
2.6
26.5
28.6
1.4
1.5
1.6
11.8
9.0
2.5
24.9
26.4
Oral Quinine
0.2
0.4
0.0
0.2
0.1
0.0
0.4
0.8
Quinine IV/IM
0.2
0.2
0.1
0.2
0.1
0.0
0.4
0.6
3. Oral artemisinin monotherapy
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
4. Non-oral artemisinin monotherapy
0.1
0.2
0.3
0.6
0.2
0.0
1.2
1.4
0.1
0.1
0.1
0.0
0.1
0.0
0.2
0.3
0.0
0.1
0.3
0.6
0.1
0.0
1.0
1.1
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.3
0.4
0.5
0.8
0.3
0.0
1.6
2.0
9.4
12.3
11.7
40.6
30.5
4.9
87.7
100.0
5. Any treatment for severe malaria
OUTLET TYPE TOTAL****
*
A total of 35,645.28 AETDs were reportedly sold or distributed in the previous seven days. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and drug
category.
*** Row sum – market share for the specified antimalarial medicine.
**** Column sum – market share for the specified outlet type.
Categories 1 through 4 sum to 100% in the far-right column – antimalarial total column.
A total of 6,651 antimalarials were audited. Of these, 325 audited antimalarials were not included in market share calculations due to incomplete or inconsistent information.
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Page 48
Table A9: Antimalarial market share across outlet type
AETDs sold or distributed in the previous week by antimalarial type as
a percentage of all AETDs sold / distributed within each outlet type: *
1. Any ACT
Artesunate Sulfadoxine Pyrimethamine (ASSP)
DHA PPQ
Public
Health
Facility
%
79.5
%
81.2
Private
For-Profit
Facility
%
81.7
79.0
78.2
71.3
51.7
58.2
42.6
56.1
0.0
0.5
0.0
2.9
0.6
6.9
0.6
11.7
0.3
7.3
0.2
3.1
0.5
9.0
TOTAL
Public
Registered
Pharmacy
Unregistered
Pharmacy
General
Retailer
TOTAL
Private
%
67.4
%
68.1
%
46.7
%
68.4
78.9
76.6
58.9
42.8
53.3
36.0
48.2
41.0
39.2
47.3
34.8
46.1
28.5
40.0
37.9
37.3
11.6
8.0
7.2
7.5
8.2
0.6
4.7
22.7
24.6
14.9
10.7
20.2
76.8
77.7
74.3
53.4
59.4
40.7
57.6
19.4
17.0
15.3
31.1
31.1
53.3
30.2
15.4
12.1
13.4
29.2
29.4
51.8
28.4
Oral Quinine
1.9
3.1
0.4
0.5
0.4
0.0
0.4
Quinine IV/IM
1.8
1.6
0.9
0.5
0.3
0.0
0.5
0.0
0.0
0.1
0.0
0.0
0.0
0.0
1.1
1.7
2.9
1.5
0.7
0.0
1.3
1.0
0.8
0.5
0.0
0.2
0.0
0.2
0.1
0.0
2.9
0.9
0.0
3.3
2.1
0.2
3.9
1.4
0.0
2.0
0.5
0.0
1.0
0.0
0.0
0.0
1.1
0.0
1.8
100
100
100
100
100
100
100
AETDs reportedly sold or distributed in the previous seven days: 2,883.8 public health facilities; 86.5 community health workers; 839.0 private not for-profit facilities; 4,077.4 private for-profit facilities;
15,788.6 registered pharmacies; 10,777.1 unregistered pharmacies; 1,192.9 general retailers. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and
drug category.

At the time of the 2014 Kenya ACTwatch outlet survey, artesunate amodiaquine was Kenya's first line treatment for uncomplicated malaria.
Categories 1 through 4 sum to 100% within each column.
A total of 6,651 antimalarials were audited. Of these, 325 audited antimalarials were not included in market share calculations due to due to incomplete or inconsistent information, including the following
number of antimalarials by outlet type: 27 public health facilities; 1 community health worker; 1 private not for-profit facility; 80 private for-profit facilities; 61 registered pharmacies; 123 unregistered
pharmacies, 32 general retailers.
*
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Page 49
Table A10: Malaria blood testing market share
Public
Health
Facility
TOTAL
Public
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
TOTAL
Private
BLOOD TEST
TOTAL***
%
%
%
%
%
%
%
%
1. Malaria microscopy
31.4
37.3
36.0
0.8
1.3
0.0
38.1
75.4
2. RDT
14.8
15.9
6.4
0.4
1.9
0.0
8.7
24.6
46.2
53.3
42.3
1.2
3.2
0.0
46.7
100.0
Number of malaria blood tests provided in
the previous week by outlet type and
blood test type as a percentage of all blood
tests provided:*
* A total of 16,815 malaria microscopy tests and 4,536 RDTs were reportedly administered in the previous seven days.
*** Row sum – market share for the specified type of blood testing medicine.
Categories 1 and 2 sum to 100% in the far-right column – malaria blood testing total column.
A total of 788 malaria blood tests were audited. Of these, 22 malaria microscopy tests and 8 RDTs were not included in market share calculations due to incomplete or inconsistent information.
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Page 50
Table A11: Malaria blood testing market share, across outlet type
Public
Health
Facility
TOTAL
Public /
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
TOTAL
Private
BLOOD TEST
TOTAL***
%
%
%
%
%
%
%
%
1. Malaria microscopy
68.0
70.1
84.9
65.4
41.5
0.0
81.5
75.4
2. RDT
32.0
29.9
15.1
34.6
58.5
0.0
18.5
24.6
ACCESS BIO INC.
99.1
99.1
54.1
78.7
95.8
0.0
64.2
86.8
STANDARD DIAGNOSTICS INC.
0.5
0.5
25.8
2.4
1.1
0.0
19.3
7.2
CTK BIOTECH INC.
0.0
0.0
0.5
8.1
0.4
0.0
0.8
0.3
Other
0.3
0.4
14.4
10.8
2.8
0.0
11.7
4.4
Number of malaria blood tests provided in
the previous week by blood test type as a
percentage of all blood tests provided
within each outlet type:*
Total blood testing market
Malaria RDT market 
Unknown
0.0
0.0
5.3
0.0
0.0
0.0
3.9
1.4
Checkmark RDT
0.0
0.0
0.7
6.0
0.0
0.0
0.8
0.3
* 21,351 malaria blood tests reportedly administered in the previous seven days: 9,250 public health facilities; 55 community health workers; 1,310 private not for-profit facilities; 9,712 private for-profit
facilities; 340 registered pharmacies; 684 unregistered pharmacies.
*** Categories 1 through 2 sum to 100% in within each column.
 The manufacturer information was missing for 8 RDTs audited.
A total of 788 malaria blood tests were audited. Of these, 22 malaria microscopy tests and 8 RDTs were not included in market share calculations due to incomplete or inconsistent information.
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Page 51
Table A12: Provider case management knowledge and practices, by outlet type
Proportion of providers who:
Would refer a 2 year old child
with symptoms of severe
malaria to a health facility
Yes, would refer to health
facility
Would recommend that a
client with a negative malaria
blood test take an
antimalarial
Yes – sometimes
Yes – always
Circumstances cited for
recommending antimalarial
treatment to a client who
tested negative for malaria:*
Public
Health
Facility
%
(95% CI)
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
-
N=59
-
NA
N=457
ALL
Public
92.0
(79.5, 97.1)
N=561
NA
N=360
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
N=490
N=550
N=403
N=1,443
N=1,502
90.6
84.9
88.4
87.0
87.3
(87.8, 92.9)
(82.0, 87.4)
(83.8, 91.8)
(84.5, 89.1)
(85.0, 89.4)
N=429
N=457
N=143
N=1,389
N=1,950
21.3
21.8
30.6
30.0
30.0
11.2
27.1
26.1
(17.9, 25.2)
(15.7, 29.3)
(27.3, 34.2)
(27.0, 33.3)
(26.7, 33.5)
(7.8, 15.8)
(25.0, 29.2)
(23.8, 28.6)
4.7
3.4
6.1
2.7
2.2
7.3
4.3
4.2
(3.2, 7.0)
(2.4, 4.6)
(4.1, 8.9)
(1.9, 3.8)
(1.2, 3.7)
(3.0, 16.7)
(3.2, 5.9)
(3.1, 5.5)
N=103
N=130
N=130
N=126
N=146
N=24
N=426
N=556
Patient has signs and
symptoms of malaria.
98.6
94.9
88.6
90.6
86.2
70.7
86.1
87.4
(96.3, 99.4)
(90.0, 97.5)
(84.7, 91.6)
(86.6, 93.5)
(82.8, 89.0)
(49.0, 85.8)
(82.9, 88.7)
(84.4, 89.9)
Provider doesn't trust the
test results.
19.4
16.3
7.6
11.6
15.8
24.4
13.1
13.6
(12.9, 28.1)
(9.9, 25.8)
(5.3, 10.7)
(8.1, 16.4)
(11.8, 21.0)
(6.4, 60.6)
(9.8, 17.3)
(10.5, 17.4)
8.4
3.9
4.0
10.1
7.0
2.0
5.7
5.4
(5.0, 13.8)
(2.1, 6.9)
(2.3, 6.8)
(7.3, 13.7)
(5.1, 9.5)
(0.6, 6.2)
(4.2, 7.5)
(4.1, 7.0)
81.1
74.4
87.6
83.8
77.9
89.3
83.3
82.0
(65.4, 90.7)
(57.6, 86.2)
(81.2, 92.0)
(74.2, 90.4)
(65.9, 86.6)
(75.6, 95.8)
(76.1, 88.7)
(74.4, 87.7)
When the patient asks for
antimalarial treatment.
Other (all other reasons)
Provider questions were administered to one staff member working in each outlet eligible for a full interview (current/recent antimalarial-stocking outlets or outlets providing malaria blood testing).
* No providers were missing information on circumstances for recommending antimalarials to clients who tested negative for malaria.
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Page 52
Table A13: Provider antimalarial treatment knowledge and practices, by outlet type
Correctly state the national
first-line treatment for
uncomplicated malaria
Correctly state the first-line
dosing regimen for:
An adult
A two-year old child
Public
Health
Facility
%
(95% CI)
N=471
%
(95% CI)
N=573
Private
For-Profit
Facility
%
(95% CI)
N=375
98.7
96.1
(97.5, 99.3)
ALL
Public 1
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
N=492
%
(95% CI)
N=557
%
(95% CI)
N=408
%
(95% CI)
N=1,832
%
(95% CI)
N=2,405
92.8
96.2
91.0
29.3
71.5
74.8
(93.9, 97.5)
(90.9, 94.3)
(93.9, 97.6)
(88.9, 92.7)
(22.9, 36.6)
(64.4, 77.7)
(68.4, 80.3)
95.9
88.4
87.8
89.9
86.2
17.3
64.2
67.4
(92.9, 97.7)
(84.1, 91.6)
(85.7, 89.7)
(87.9, 91.6)
(83.8, 88.3)
(12.9, 22.6)
(57.0, 70.8)
(61.0, 73.3)
87.8
79.1
73.0
81.1
73.9
10.1
53.2
56.7
(84.4, 90.6)
(72.4, 84.4)
(69.4, 76.3)
(78.6, 83.3)
(70.6, 76.9)
(7.0, 14.3)
(47.0, 59.3)
(51.0, 62.2)
96.7
93.9
89.2
95.0
87.6
29.1
69.3
72.6
(94.6, 98.0)
(90.6, 96.2)
(86.7, 91.3)
(93.3, 96.2)
(85.7, 89.3)
(19.7, 40.7)
(61.2, 76.4)
(65.3, 78.9)
94.7
91.6
87.3
96.3
85.6
21.9
65.8
69.3
(92.6, 96.3)
(88.6, 93.8)
(84.5, 89.6)
(94.8, 97.4)
(83.0, 87.8)
(14.4, 31.8)
(57.7, 73.2)
(62.1, 75.7)
98.5
95.8
93.1
94.2
85.7
26.3
68.6
72.3
(96.3, 99.4)
98.0
(93.2, 97.4)
95.8
(91.2, 94.6)
87.7
(92.2, 95.7)
95.0
(83.3, 87.9)
82.8
(17.0, 38.3)
20.6
(60.2, 75.9)
64.4
(64.6, 78.8)
68.7
(95.7, 99.1)
(92.6, 97.6)
(85.3, 89.7)
(92.8, 96.6)
(79.6, 85.5)
(13.5, 30.2)
(56.5, 71.6)
(61.4, 75.1)
Report an ACT as the most
effective antimalarial
medicine for:
Adults
Children
Report an ACT as the
antimalarial he/she most
commonly recommends for:
Adults
Children
1
This includes 52 community health workers and 50 private not-for profit outlets

At the time of the 2014 Kenya ACTwatch outlet survey, artemether lumefantrine was Kenya's first line treatment for uncomplicated malaria.
Numbers of providers (N) in this table are the total number of providers eligible for table indicators. 20 providers had missing information on the national first-line treatment, 19 on the first-line dosing
regimen for adults and children, 18 on the most effective antimalarial medicine for adults and children and 19 on the most often recommended antimalarial for adults and children.
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Page 53
Results Section B: Core Indicators across Urban/Rural Location
Table B1: Availability of antimalarials, among all screened outlets, by outlet type, across urban/rural location
stocking:
Any antimalarial at the time
of survey visit
Urban
Rural
Public
Health
Facility
Private Not ForProfit Facility
ALL
Public / NotFor-Profit**
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=182
Rural N=303
Urban N=34
Rural N=24
Urban N=509
Rural N=587
Urban N=351
Rural N=102
Urban N=454
Rural N=49
Urban N=469
Rural N=103
Urban N=6,342
Rural N=3,608
Urban N=7,715
Rural N=3,865
Urban N=8,224
Rural N=4,452
84.4
(78.4, 89.0)
98.5
(96.9, 99.2)
77.7
(69.4, 84.3)
78.7
(59.5, 90.3)
15.8
(11.5, 21.3)
21.2
(13.6, 31.6)
72.8
(66.9, 78.1)
74.9
(65.3, 82.6)
96.2
(93.9, 97.6)
97.8
(87.9, 99.6)
93.3
(91.8, 94.5)
93.0
(87.3, 96.2)
1.4
(1.0, 1.9)
5.3
(3.6, 7.8)
11.5
(10.5, 12.5)
9.3
(7.6, 11.4)
11.7
(10.7, 12.8)
10.5
(8.9, 12.5)
72.3
(64.5, 78.9)
80.9
(75.2, 85.6)
72.7
(63.8, 80.1)
78.7
(59.5, 90.3)
13.2
(9.4, 18.2)
18.9
(12.0, 28.5)
68.1
(63.2, 72.7)
67.1
(57.5, 75.3)
96.1
(93.8, 97.5)
97.8
(87.9, 99.6)
86.8
(83.9, 89.3)
81.7
(71.9, 88.6)
0.4
(0.3, 0.7)
1.3
(0.6, 3.0)
10.1
(9.1, 11.2)
5.1
(4.0, 6.5)
10.3
(9.3, 11.3)
6.5
(5.2, 8.1)
72.3
(64.5, 78.9)
80.9
(75.2, 85.6)
72.7
(63.8, 80.1)
78.7
(59.5, 90.3)
13.2
(9.4, 18.2)
18.9
(12.0, 28.5)
66.6
(61.9, 71.0)
65.4
(55.5, 74.2)
94.2
(91.4, 96.1)
94.9
(83.2, 98.6)
84.9
(82.1, 87.3)
79.8
(70.2, 86.8)
0.4
(0.3, 0.7)
1.3
(0.6, 3.0)
9.9
(8.9, 10.9)
5.0
(3.9, 6.4)
10.1
(9.1, 11.1)
6.4
(5.1, 8.0)
0.3
(0.1, 0.8)
0.3
(0.1, 1.9)
0.0
0.0
-
0.0
(0.0, 0.1)
0.0
(0.0, 0.3)
1.9
(1.0, 3.3)
2.7
(1.0, 7.0)
12.8
(9.1, 17.9)
3.8
(1.1, 12.4)
4.4
(2.5, 7.7)
1.4
(0.4, 4.7)
0.1
(0.0, 0.2)
0.0
-
0.6
(0.4, 0.9)
0.1
(0.1, 0.2)
0.6
(0.4, 0.8)
0.1
(0.1, 0.2)
0.0
0.0
-
0.0
0.0
-
0.0
0.0
-
5.3
(3.9, 7.4)
1.7
(0.5, 6.1)
17.2
(14.1, 20.9)
6.5
(2.6, 15.1)
6.2
(5.1, 7.5)
5.8
(1.9, 16.1)
0.0
0.0
-
0.9
(0.7, 1.0)
0.2
(0.1, 0.5)
0.8
(0.7, 1.0)
0.2
(0.1, 0.5)
Any ACT
Urban
Rural
(AL)
Urban
Rural
Urban
Rural
(ASAQ)
Urban
Rural
www.ACTwatch.info
Page 54
stocking:
DHAPPQ
Urban
Rural
Public
Health
Facility
ALL
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=182
Rural N=303
Urban N=34
Rural N=24
Urban N=509
Rural N=587
Urban N=351
Rural N=102
Urban N=454
Rural N=49
Urban N=469
Rural N=103
Urban N=6,342
Rural N=3,608
Urban N=7,715
Rural N=3,865
Urban N=8,224
Rural N=4,452
3.9
(2.5, 6.0)
0.5
(0.1, 2.8)
23.2
(15.0, 34.0)
12.9
(5.0, 29.5)
2.1
(1.3, 3.4)
0.9
(0.4, 2.1)
24.4
(20.6, 28.6)
17.9
(12.0, 25.8)
74.1
(67.5, 79.7)
61.0
(43.8, 75.8)
36.4
(30.0, 43.4)
25.4
(14.6, 40.5)
0.1
(0.0, 0.2)
0.0
(0.0, 0.2)
4.4
(3.8, 5.2)
1.2
(0.8, 1.8)
4.3
(3.7, 5.0)
1.2
(0.8, 1.7)
72.0
(64.3, 78.6)
80.9
(75.2, 85.6)
72.7
(63.8, 80.1)
78.7
(59.5, 90.3)
13.2
(9.4, 18.2)
18.9
(12.0, 28.5)
60.0
(55.4, 64.5)
65.4
(55.5, 74.2)
86.7
(84.3, 88.8)
93.3
(81.8, 97.7)
78.7
(76.5, 80.7)
77.8
(67.7, 85.4)
0.4
(0.2, 0.7)
1.3
(0.6, 3.0)
9.0
(8.2, 10.0)
4.9
(3.8, 6.3)
9.3
(8.4, 10.3)
6.3
(5.1, 7.9)
72.0
(64.3, 78.6)
80.9
(75.2, 85.6)
72.7
(63.8, 80.1)
78.7
(59.5, 90.3)
13.2
(9.4, 18.2)
18.9
(12.0, 28.5)
59.4
(54.9, 63.7)
64.9
(55.0, 73.6)
85.0
(82.4, 87.2)
93.3
(81.8, 97.7)
78.2
(75.9, 80.3)
76.9
(67.2, 84.4)
0.4
(0.2, 0.7)
1.3
(0.6, 3.0)
9.0
(8.1, 9.9)
4.9
(3.8, 6.3)
9.2
(8.3, 10.2)
6.3
(5.0, 7.9)
30.7
(22.5, 40.3)
25.2
(18.3, 33.7)
47.9
(39.1, 56.9)
54.5
(27.3, 79.2)
7.0
(4.6, 10.7)
7.9
(4.2, 14.3)
52.8
(48.9, 56.6)
57.7
(45.9, 68.7)
82.6
(80.3, 84.7)
84.1
(70.2, 92.2)
71.8
(68.8, 74.6)
67.7
(53.9, 78.9)
0.4
(0.2, 0.6)
1.0
(0.5, 2.3)
8.2
(7.4, 9.0)
4.2
(3.2, 5.6)
8.1
(7.3, 9.0)
4.6
(3.5, 6.0)
58.4
(51.7, 64.8)
69.1
31.3
(22.5, 41.8)
55.6
8.5
(6.0, 11.7)
15.2
16.2
(13.2, 19.7)
10.7
16.9
(14.0, 20.2)
21.3
15.3
(13.2, 17.8)
20.5
0.1
(0.0, 0.2)
0.3
2.0
(1.7, 2.3)
1.1
2.3
(2.1, 2.6)
2.5
(60.3, 76.7)
(27.6, 80.4)
(9.4, 23.7)
(5.9, 18.5)
(12.9, 33.1)
(13.8, 29.4)
(0.1, 1.1)
(0.7, 1.5)
(1.8, 3.5)
59.4
(49.7, 68.4)
69.7
(62.8, 75.7)
31.0
(23.0, 40.4)
57.1
(29.8, 80.7)
8.5
(5.8, 12.3)
14.8
(9.1, 23.3)
27.9
(25.0, 31.0)
23.2
(14.1, 35.7)
44.1
(40.5, 47.8)
42.7
(31.2, 55.0)
34.6
(31.6, 37.8)
34.1
(21.8, 49.1)
0.2
(0.1, 0.3)
0.6
(0.2, 1.5)
4.1
(3.7, 4.6)
2.0
(1.3, 3.1)
4.4
(4.0, 4.8)
3.3
(2.4, 4.6)
ACT)
Urban
Rural
QA AL
Urban
Rural
leaf’ logo
Urban
Rural
QA ACT without the
Urban
Rural
QA ACT – child (<5 years)
Urban
Rural
www.ACTwatch.info
Page 55
stocking:
QA ACT - adults
Urban
Rural
Public
Health
Facility
ALL
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=182
Rural N=303
Urban N=34
Rural N=24
Urban N=509
Rural N=587
Urban N=351
Rural N=102
Urban N=454
Rural N=49
Urban N=469
Rural N=103
Urban N=6,342
Rural N=3,608
Urban N=7,715
Rural N=3,865
Urban N=8,224
Rural N=4,452
37.9
(29.5, 47.1)
40.6
(31.4, 50.5)
66.1
(55.8, 75.0)
60.1
(32.6, 82.5)
9.1
(6.3, 13.0)
12.0
(6.6, 20.6)
49.5
(44.3, 54.8)
51.7
(40.0, 63.2)
77.0
(74.1, 79.7)
85.6
(71.2, 93.4)
67.4
(64.6, 70.1)
63.8
(52.8, 73.5)
0.3
(0.2, 0.6)
0.9
(0.4, 2.0)
7.7
(6.8, 8.7)
3.9
(3.0, 4.9)
7.8
(6.9, 8.7)
4.7
(3.7, 5.9)
4.7
(3.2, 6.8)
0.8
(0.2, 2.8)
23.2
(15.0, 34.0)
44.2
(18.1, 74.0)
2.2
(1.4, 3.5)
3.0
(0.9, 9.2)
39.5
(36.4, 42.8)
24.9
(18.5, 32.7)
85.6
(80.8, 89.4)
67.7
(50.7, 81.0)
50.6
(43.5, 57.6)
30.8
(19.3, 45.3)
0.1
(0.0, 0.2)
0.0
(0.0, 0.2)
6.1
(5.4, 7.0)
1.5
(1.1, 2.1)
5.9
(5.2, 6.8)
1.7
(1.2, 2.3)
72.1
(64.3, 78.7)
78.6
(71.8, 84.2)
70.2
(62.1, 77.2)
76.0
(56.6, 88.5)
13.0
(9.3, 17.9)
18.4
(11.7, 27.8)
65.3
(60.9, 69.5)
66.4
(57.2, 74.6)
94.4
(92.1, 96.0)
95.7
(77.2, 99.3)
83.9
(81.3, 86.2)
79.3
(69.6, 86.5)
0.4
(0.3, 0.7)
1.3
(0.6, 2.9)
9.7
(8.8, 10.7)
5.0
(3.9, 6.3)
9.9
(9.0, 10.9)
6.3
(5.1, 7.9)
60.9
(53.0, 68.2)
76.4
(69.0, 82.5)
43.7
(34.6, 53.2)
61.2
(35.5, 81.9)
10.5
(7.7, 14.1)
14.2
(8.7, 22.4)
36.8
(32.0, 41.8)
43.6
(31.6, 56.4)
61.0
(56.7, 65.2)
75.3
(62.8, 84.6)
63.7
(60.6, 66.7)
73.1
(61.1, 82.5)
1.0
(0.7, 1.5)
4.5
(2.9, 6.9)
7.2
(6.5, 8.1)
7.2
(5.6, 9.3)
7.4
(6.7, 8.2)
7.9
(6.4, 9.8)
12.4
(8.2, 18.3)
15.0
(8.7, 24.7)
18.4
(11.5, 28.2)
9.2
(2.2, 30.8)
3.6
(2.4, 5.3)
2.6
(1.6, 4.3)
17.4
(14.8, 20.3)
20.7
(14.7, 28.3)
50.2
(46.6, 53.7)
60.3
(50.4, 69.5)
51.9
(49.2, 54.6)
60.4
(46.5, 72.8)
0.8
(0.5, 1.4)
3.3
(2.1, 5.3)
5.3
(4.7, 6.0)
5.3
(4.0, 6.9)
5.2
(4.6, 5.9)
5.0
(3.8, 6.5)
35.0
(28.3, 42.3)
46.4
(38.4, 54.5)
22.0
(14.5, 32.1)
45.5
(20.8, 72.6)
5.3
(4.0, 7.0)
9.2
(5.2, 15.8)
11.4
(9.5, 13.6)
14.0
(6.6, 27.2)
19.5
(15.6, 24.1)
30.5
(19.1, 45.0)
20.6
(17.4, 24.3)
40.7
(27.4, 55.6)
0.0
(0.0, 0.1)
0.2
(0.1, 1.1)
2.1
(1.8, 2.4)
1.6
(1.1, 2.4)
2.2
(2.0, 2.6)
2.4
(1.7, 3.3)
(non-QA ACT)
Urban
Rural
Urban
Rural
Any non-artemisinin therapy
Urban
Rural
Urban
Rural
Oral Quinine
Urban
Rural
www.ACTwatch.info
Page 56
stocking:
Quinine IV/IM
Urban
Rural
Public
Health
Facility
ALL
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=182
Rural N=303
Urban N=34
Rural N=24
Urban N=509
Rural N=587
Urban N=351
Rural N=102
Urban N=454
Rural N=49
Urban N=469
Rural N=103
Urban N=6,342
Rural N=3,608
Urban N=7,715
Rural N=3,865
Urban N=8,224
Rural N=4,452
43.8
(36.0, 51.8)
62.0
(53.7, 69.6)
31.5
(22.5, 42.2)
52.7
(25.1, 78.8)
6.9
(5.0, 9.5)
11.7
(7.0, 19.0)
22.3
(19.4, 25.4)
24.0
(14.7, 36.6)
9.7
(7.3, 12.7)
31.6
(18.7, 48.3)
7.4
(4.9, 11.1)
24.8
(16.6, 35.4)
0.0
0.0
(0.0, 0.2)
1.6
(1.4, 1.9)
1.3
(0.9, 1.9)
1.9
(1.6, 2.3)
2.3
(1.8, 3.1)
2.0
(0.9, 4.2)
0.0
-
0.0
3.8
(0.6, 21.1)
0.2
(0.1, 0.5)
0.2
(0.0, 1.5)
4.6
(3.0, 7.2)
1.2
(0.2, 6.6)
14.6
(12.3, 17.4)
7.5
(2.6, 19.6)
9.0
(7.3, 11.0)
6.3
(2.5, 15.4)
0.2
(0.1, 0.3)
1.0
(0.3, 3.5)
1.1
(0.9, 1.4)
1.2
(0.4, 3.5)
1.1
(0.9, 1.3)
1.1
(0.4, 3.2)
0.0
0.0
-
0.0
0.0
-
0.0
0.0
-
0.1
(0.0, 0.4)
0.0
-
0.0
0.0
-
0.0
0.0
-
0.0
0.0
-
0.0
0.0
-
0.0
0.0
-
46.2
(40.9, 51.5)
54.2
(45.9, 62.3)
46.6
(38.1, 55.2)
50.4
(26.0, 74.5)
8.3
(6.0, 11.3)
10.5
(6.1, 17.5)
35.5
(32.6, 38.5)
20.8
(13.2, 31.2)
24.5
(19.8, 29.8)
22.3
(13.5, 34.5)
9.1
(6.7, 12.2)
7.2
(3.3, 14.9)
0.0
(0.0, 0.1)
0.0
-
2.6
(2.2, 3.0)
0.7
(0.5, 1.1)
2.9
(2.5, 3.3)
1.7
(1.3, 2.2)
6.4
(4.6, 8.9)
2.2
(0.7, 6.6)
34.4
(25.7, 44.3)
50.4
(26.0, 74.5)
3.2
(1.9, 5.3)
3.6
(1.2, 10.0)
31.2
(28.1, 34.5)
17.7
(12.4, 24.7)
24.0
(19.3, 29.4)
22.3
(13.5, 34.5)
8.9
(6.6, 11.8)
7.2
(3.3, 14.9)
0.0
(0.0, 0.1)
0.0
-
2.4
(2.1, 2.7)
0.6
(0.4, 1.0)
2.4
(2.1, 2.8)
0.9
(0.6, 1.4)
43.9
(38.6, 49.4)
53.8
(45.4, 62.1)
22.0
(13.5, 33.7)
0.0
-
6.2
(4.5, 8.5)
7.2
(4.4, 11.6)
7.6
(6.2, 9.4)
3.1
(0.5, 16.4)
4.4
(2.5, 7.4)
2.7
(0.5, 12.8)
1.6
(0.7, 3.4)
0.0
-
0.0
0.0
-
0.5
(0.4, 0.7)
0.1
(0.0, 0.4)
0.8
(0.7, 1.0)
0.8
(0.6, 1.1)
therapy
Urban
Rural
Oral artemisinin
monotherapy
Urban
Rural
monotherapy
Urban
Rural
Urban
Rural
Urban
Rural
www.ACTwatch.info
Page 57
stocking:
Urban
Rural
Public
Health
Facility
ALL
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=182
Rural N=303
Urban N=34
Rural N=24
Urban N=509
Rural N=587
Urban N=351
Rural N=102
Urban N=454
Rural N=49
Urban N=469
Rural N=103
Urban N=6,342
Rural N=3,608
Urban N=7,715
Rural N=3,865
Urban N=8,224
Rural N=4,452
0.0
0.0
-
0.0
0.0
-
0.0
0.0
-
1.9
(1.2, 3.1)
0.0
-
5.4
(3.2, 9.1)
2.4
(0.4, 13.7)
1.1
(0.6, 2.1)
0.0
-
0.0
0.0
-
0.2
(0.1, 0.4)
0.0
-
0.2
(0.1, 0.4)
0.0
-
64.4
(58.5, 69.9)
81.4
(74.7, 86.6)
54.3
(44.6, 63.7)
68.3
(45.3, 84.9)
10.8
(7.9, 14.5)
15.3
(9.5, 23.8)
45.2
(42.5, 48.1)
38.3
(27.4, 50.6)
26.0
(21.3, 31.4)
38.1
(23.7, 54.9)
13.1
(9.8, 17.3)
25.9
(17.8, 36.1)
0.0
(0.0, 0.1)
0.0
(0.0, 0.2)
3.3
(2.9, 3.7)
1.7
(1.2, 2.3)
3.7
(3.3, 4.2)
3.0
(2.5, 3.7)
malaria
Urban
Rural
** The denominator includes 553 community health workers. Urban: 293 outlets. Rural: 260 outlets.
www.ACTwatch.info
Page 58
Table B2: Availability of antimalarials, among all outlets stocking at least one antimalarial, by outlet type, across urban/rural location
Proportion of outlets* stocking:
Public
Health
Facility
%
(95% CI)
%
(95% CI)
ALL
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
Urban N=160
Rural N=297
Urban N=27
Rural N=16
Urban N=190
Rural N=327
85.6
(80.0, 89.9)
82.2
(76.6, 86.6)
93.5
(87.7, 96.7)
100.0
-
85.6
(80.0, 89.9)
82.2
(76.6, 86.6)
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=262
Rural N=80
Urban N=439
Rural N=48
Urban N=440
Rural N=95
Urban N=72
Rural N=180
Urban N=1,213
Rural N=403
Urban N=1,403
Rural N=730
83.8
(78.3, 88.2)
88.9
(83.9, 92.5)
93.5
(91.3, 95.2)
89.5
(82.0, 94.1)
99.9
(99.7, 99.9)
100.0
-
93.1
(90.2, 95.2)
87.9
(75.8, 94.4)
32.0
(19.4, 47.8)
25.0
(11.1, 47.1)
87.7
(84.1, 90.6)
54.4
(41.1, 67.1)
87.4
(83.8, 90.3)
61.5
(48.8, 72.7)
93.5
(87.7, 96.7)
100.0
-
83.8
(78.3, 88.2)
88.9
(83.9, 92.5)
91.5
(89.2, 93.3)
87.3
(80.1, 92.2)
97.9
(96.9, 98.6)
97.0
(84.0, 99.5)
91.0
(88.3, 93.1)
85.8
(74.5, 92.6)
32.0
(19.4, 47.8)
25.0
(11.1, 47.1)
85.9
(82.5, 88.7)
53.4
(40.3, 66.1)
85.7
(82.3, 88.5)
60.7
(48.1, 72.0)
0.3
(0.1, 0.9)
0.3
(0.1, 1.9)
0.0
0.0
-
0.2
(0.1, 0.5)
0.2
(0.0, 1.2)
2.5
(1.4, 4.7)
3.6
(1.4, 9.3)
13.3
(9.5, 18.5)
3.9
(1.1, 12.7)
4.7
(2.7, 8.2)
1.5
(0.5, 5.0)
5.6
(1.9, 15.2)
0.0
-
5.2
(3.5, 7.7)
1.1
(0.6, 2.4)
4.9
(3.3, 7.1)
1.0
(0.5, 1.9)
0.0
0.0
-
0.0
0.0
-
0.0
0.0
-
7.3
(5.6, 9.6)
2.3
(0.6, 8.2)
17.9
(14.9, 21.4)
6.7
(2.7, 15.4)
6.7
(5.5, 8.0)
6.2
(2.1, 17.1)
0.0
0.0
-
7.6
(6.6, 8.6)
2.1
(0.8, 5.3)
7.0
(6.1, 8.0)
1.7
(0.7, 4.2)
4.6
(3.1, 6.9)
0.5
29.8
(19.3, 43.1)
16.4
13.3
(9.7, 18.0)
4.3
33.5
(27.3, 40.4)
23.9
77.0
(71.1, 82.0)
62.4
39.0
(32.1, 46.5)
27.3
5.6
(1.9, 15.2)
0.5
38.6
(33.0, 44.6)
12.8
36.7
(31.4, 42.2)
11.1
(0.1, 2.9)
(5.5, 39.8)
(1.9, 9.1)
(15.4, 35.2)
(45.2, 76.9)
(15.2, 44.1)
(0.1, 3.2)
(8.3, 19.4)
(7.3, 16.5)
85.3
(79.6, 89.6)
82.2
(76.6, 86.6)
93.5
(87.7, 96.7)
100.0
-
83.7
(78.1, 88.0)
88.9
(83.9, 92.5)
82.4
(79.3, 85.2)
87.3
(80.1, 92.2)
90.1
(88.3, 91.7)
95.3
(83.9, 98.8)
84.3
(82.4, 86.1)
83.7
(72.8, 90.7)
29.2
(17.8, 44.1)
25.0
(11.1, 47.1)
78.8
(76.0, 81.3)
52.9
(39.9, 65.5)
79.1
(76.4, 81.6)
60.2
(47.8, 71.5)
Any ACT
Urban
Rural
Urban
Rural
Urban
Rural
(ASAQ)
Urban
Rural
DHAPPQ
Urban
Rural
Urban
Rural
www.ACTwatch.info
Page 59
Public
Health
Facility
ALL
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=160
Rural N=297
Urban N=27
Rural N=16
Urban N=190
Rural N=327
Urban N=262
Rural N=80
Urban N=439
Rural N=48
Urban N=440
Rural N=95
Urban N=72
Rural N=180
Urban N=1,213
Rural N=403
Urban N=1,403
Rural N=730
85.3
(79.6, 89.6)
82.2
(76.6, 86.6)
93.5
(87.7, 96.7)
100.0
-
83.7
(78.1, 88.0)
88.9
(83.9, 92.5)
81.5
(78.2, 84.4)
86.6
(79.0, 91.7)
88.3
(86.4, 90.1)
95.3
(83.9, 98.8)
83.8
(81.7, 85.8)
82.7
(72.2, 89.8)
29.2
(17.8, 44.1)
25.0
(11.1, 47.1)
78.0
(75.3, 80.5)
52.5
(39.6, 65.0)
78.5
(75.7, 81.0)
59.9
(47.6, 71.1)
36.3
(27.5, 46.2)
25.6
(18.5, 34.3)
61.6
(50.5, 71.7)
69.2
(32.7, 91.2)
44.6
(36.5, 53.0)
37.2
(27.4, 48.2)
72.4
(67.6, 76.8)
77.1
(66.6, 85.0)
85.9
(83.9, 87.7)
86.0
(71.7, 93.7)
77.0
(74.0, 79.7)
72.7
(57.8, 83.9)
25.4
(15.3, 39.2)
19.7
(9.4, 36.9)
71.4
(68.5, 74.0)
45.2
(34.1, 56.7)
69.3
(66.3, 72.2)
43.5
(34.8, 52.7)
69.2
(62.4, 75.2)
70.2
(61.5, 77.6)
40.3
(29.3, 52.4)
70.6
(38.9, 90.0)
53.5
(46.4, 60.5)
71.7
(60.4, 80.8)
22.2
(19.1, 25.7)
14.3
(7.7, 25.0)
17.5
(14.7, 20.8)
21.8
(13.2, 33.6)
16.4
(14.1, 19.1)
22.1
(14.8, 31.6)
6.1
(3.3, 11.0)
5.3
(1.3, 18.5)
17.2
(15.6, 18.9)
11.5
(7.2, 17.8)
20.0
(18.6, 21.4)
23.8
(16.3, 33.4)
70.3
(60.9, 78.3)
70.7
(63.9, 76.8)
39.9
(29.6, 51.3)
72.6
(41.6, 90.8)
54.1
(46.0, 61.9)
69.8
(60.5, 77.8)
38.3
(34.2, 42.6)
31.0
(18.5, 47.0)
45.9
(42.2, 49.6)
43.6
(32.3, 55.7)
37.1
(34.0, 40.4)
36.7
(23.4, 52.3)
13.2
(8.3, 20.5)
10.4
(3.9, 24.9)
36.1
(34.2, 38.0)
21.5
(13.4, 32.6)
37.4
(35.6, 39.3)
31.4
(22.1, 42.4)
44.9
(36.2, 54.0)
41.2
(31.9, 51.2)
85.0
(75.4, 91.3)
76.4
(37.2, 94.6)
57.8
(50.9, 64.5)
56.3
(42.0, 69.6)
68.0
(64.8, 71.1)
69.0
(56.7, 79.0)
80.1
(77.9, 82.1)
87.5
(72.6, 94.8)
72.3
(69.4, 75.0)
68.6
(56.2, 78.8)
22.6
(13.1, 36.2)
17.3
(8.2, 32.7)
66.8
(63.4, 70.1)
41.3
(32.6, 50.5)
66.1
(62.7, 69.4)
44.4
(35.7, 53.3)
5.6
(3.9, 7.9)
0.8
(0.2, 2.8)
29.8
(19.3, 43.1)
56.2
(22.6, 84.9)
13.8
(10.3, 18.4)
14.1
(5.3, 32.2)
54.3
(49.2, 59.2)
33.2
(24.4, 43.5)
89.0
(85.5, 91.8)
69.2
(52.5, 82.0)
54.2
(46.6, 61.6)
33.2
(20.1, 49.4)
5.6
(1.9, 15.2)
0.5
(0.1, 3.2)
53.5
(48.3, 58.6)
16.2
(10.7, 23.8)
50.4
(45.3, 55.5)
15.8
(11.0, 22.0)
QA AL
Urban
Rural
leaf’ logo
Urban
Rural
QA ACT without the ‘green
leaf’ logo
Urban
Rural
QA ACT – child (<5 years)
Urban
Rural
QA ACT - adults
Urban
Rural
(non-QA ACT)
Urban
Rural
www.ACTwatch.info
Page 60
Public
Health
Facility
ALL
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=160
Rural N=297
Urban N=27
Rural N=16
Urban N=190
Rural N=327
Urban N=262
Rural N=80
Urban N=439
Rural N=48
Urban N=440
Rural N=95
Urban N=72
Rural N=180
Urban N=1,213
Rural N=403
Urban N=1,403
Rural N=730
85.4
(79.7, 89.7)
79.8
(73.0, 85.3)
90.3
(84.5, 94.1)
96.5
(81.5, 99.4)
82.6
(77.2, 86.9)
86.6
(80.4, 91.1)
89.7
(87.4, 91.6)
88.7
(80.9, 93.6)
98.1
(96.9, 98.9)
97.8
(87.2, 99.7)
90.0
(87.4, 92.1)
85.2
(73.4, 92.4)
29.7
(18.3, 44.2)
24.5
(10.9, 46.1)
84.6
(81.3, 87.4)
53.3
(40.4, 65.8)
84.5
(81.1, 87.3)
60.1
(47.8, 71.2)
72.1
(64.0, 79.0)
77.6
(70.2, 83.6)
56.3
(45.1, 66.8)
77.8
(51.5, 92.0)
66.6
(59.4, 73.1)
66.9
(55.0, 77.0)
50.5
(45.8, 55.2)
58.2
(44.0, 71.2)
63.4
(59.4, 67.2)
76.9
(64.6, 85.9)
68.3
(65.0, 71.4)
78.6
(66.7, 87.1)
74.0
(58.9, 85.0)
83.7
(65.9, 93.2)
63.0
(59.8, 66.2)
77.5
(67.1, 85.2)
63.3
(60.2, 66.3)
75.3
(66.9, 82.2)
14.7
(10.0, 21.1)
15.2
(8.8, 25.0)
23.7
(15.1, 35.2)
11.7
(2.8, 37.4)
22.5
(17.8, 28.1)
12.3
(7.3, 20.0)
23.8
(20.9, 27.0)
27.6
(19.2, 37.9)
52.1
(48.5, 55.8)
61.6
(51.4, 71.0)
55.6
(53.0, 58.2)
64.9
(50.3, 77.2)
60.1
(44.2, 74.1)
62.8
(43.5, 78.8)
46.3
(43.5, 49.1)
56.6
(45.6, 67.0)
44.4
(41.9, 47.1)
47.6
(38.3, 57.1)
41.5
(33.5, 49.9)
47.1
(39.0, 55.4)
28.4
(18.9, 40.2)
57.8
(29.0, 82.1)
33.6
(27.6, 40.2)
43.2
(31.9, 55.1)
15.6
(13.6, 17.9)
18.7
(9.1, 34.5)
20.2
(16.3, 24.8)
31.2
(19.7, 45.7)
22.1
(18.6, 26.1)
43.8
(30.1, 58.5)
2.8
(1.0, 7.8)
4.5
(0.9, 19.5)
17.9
(16.1, 20.0)
17.5
(11.7, 25.4)
19.1
(17.3, 21.2)
22.8
(16.4, 30.7)
51.8
(43.5, 60.1)
62.9
(54.5, 70.6)
40.6
(29.3, 53.0)
67.0
(36.5, 87.7)
43.8
(37.4, 50.5)
55.2
(43.1, 66.7)
30.6
(26.7, 34.8)
32.0
(20.6, 46.1)
10.1
(7.7, 13.2)
32.3
(19.2, 48.9)
8.0
(5.3, 11.9)
26.7
(18.1, 37.5)
0.0
0.5
(0.1, 3.2)
14.1
(11.9, 16.6)
13.7
(8.8, 20.6)
16.4
(13.9, 19.3)
22.1
(16.4, 29.1)
2.4
(1.1, 4.9)
0.0
-
0.0
4.8
(0.7, 26.6)
1.3
(0.6, 2.8)
1.2
(0.2, 6.6)
6.4
(4.3, 9.3)
1.6
(0.3, 8.9)
15.2
(12.8, 18.0)
7.6
(2.7, 20.1)
9.6
(7.9, 11.7)
6.8
(2.6, 16.5)
14.0
(8.5, 22.1)
19.5
(6.0, 47.9)
9.8
(8.5, 11.3)
12.7
(4.4, 31.4)
9.1
(7.9, 10.6)
10.3
(3.6, 26.3)
Urban
Rural
Urban
Rural
Urban
Rural
Oral Quinine
Urban
Rural
Quinine IV/IM
Urban
Rural
therapy
Urban
Rural
www.ACTwatch.info
Page 61
Public
Health
Facility
ALL
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=160
Rural N=297
Urban N=27
Rural N=16
Urban N=190
Rural N=327
Urban N=262
Rural N=80
Urban N=439
Rural N=48
Urban N=440
Rural N=95
Urban N=72
Rural N=180
Urban N=1,213
Rural N=403
Urban N=1,403
Rural N=730
0.0
0.0
-
0.0
0.0
-
0.0
0.0
-
0.2
(0.1, 0.6)
0.0
-
0.0
0.0
-
0.0
0.0
-
0.0
0.0
-
0.1
(0.0, 0.2)
0.0
-
0.1
(0.0, 0.2)
0.0
-
54.7
(47.2, 61.9)
55.1
(46.5, 63.3)
59.9
(49.7, 69.3)
64.0
(35.5, 85.1)
52.4
(45.7, 59.0)
49.6
(38.9, 60.4)
48.7
(44.4, 53.1)
27.8
(18.2, 39.9)
25.5
(20.9, 30.7)
22.8
(14.0, 35.0)
9.7
(7.1, 13.1)
7.7
(3.6, 15.9)
2.8
(1.0, 7.8)
0.0
-
22.5
(19.5, 25.8)
7.7
(4.8, 12.0)
24.8
(21.7, 28.1)
16.2
(12.6, 20.7)
7.6
(5.3, 10.7)
2.2
(0.7, 6.7)
44.3
(32.8, 56.3)
64.0
(35.5, 85.1)
20.2
(14.8, 26.9)
16.8
(6.9, 35.6)
42.9
(39.3, 46.5)
23.7
(17.0, 32.0)
24.9
(20.3, 30.2)
22.8
(14.0, 35.0)
9.5
(7.1, 12.7)
7.7
(3.6, 15.9)
2.8
(1.0, 7.8)
0.0
-
20.6
(18.0, 23.4)
6.9
(4.4, 10.6)
20.5
(18.0, 23.3)
8.9
(5.9, 13.3)
52.0
(44.5, 59.5)
54.7
(46.0, 63.0)
28.3
(17.8, 41.8)
0.0
-
39.5
(32.1, 47.5)
33.9
(24.7, 44.5)
10.5
(8.2, 13.3)
4.1
(0.7, 20.8)
4.5
(2.7, 7.7)
2.8
(0.5, 13.0)
1.7
(0.8, 3.6)
0.0
-
0.0
0.0
-
4.5
(3.2, 6.1)
0.8
(0.2, 4.4)
7.1
(5.6, 9.0)
7.6
(5.6, 10.2)
0.0
0.0
-
0.0
0.0
-
0.0
0.0
-
2.6
(1.6, 4.3)
0.0
-
5.7
(3.4, 9.3)
2.4
(0.4, 14.0)
1.2
(0.7, 2.2)
0.0
-
0.0
0.0
-
2.1
(1.3, 3.3)
0.0
(0.0, 0.3)
1.9
(1.2, 3.0)
0.0
(0.0, 0.2)
Urban
Rural
monotherapy
Urban
Rural
Urban
Rural
Urban
Rural
Urban
Rural
www.ACTwatch.info
Page 62
Public
Health
Facility
ALL
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=160
Rural N=297
Urban N=27
Rural N=16
Urban N=190
Rural N=327
Urban N=262
Rural N=80
Urban N=439
Rural N=48
Urban N=440
Rural N=95
Urban N=72
Rural N=180
Urban N=1,213
Rural N=403
Urban N=1,403
Rural N=730
76.3
(69.7, 81.8)
82.7
(76.0, 87.8)
69.9
(58.1, 79.5)
86.8
(62.7, 96.2)
68.2
(61.5, 74.2)
72.2
(60.0, 81.9)
62.1
(57.7, 66.4)
51.1
(38.5, 63.6)
27.1
(22.4, 32.3)
38.9
(24.4, 55.7)
14.1
(10.5, 18.6)
27.9
(19.4, 38.2)
2.8
(1.0, 7.8)
0.5
(0.1, 3.2)
28.7
(25.4, 32.2)
17.7
(12.1, 25.2)
31.7
(28.1, 35.6)
28.8
(22.5, 36.1)
malaria
Urban
Rural
* Antimalarial-stocking outlets have at least one antimalarial in stock on the day of the survey, verified by presence of at least one antimalarial recorded in the antimalarial audit sheet. The denominator
includes urban and rural outlets that met screening criteria and completed full interviews. 67 outlets in the denominator had partial interviews. Urban: 48 outlets. Rural: 19 outlets.
www.ACTwatch.info
Page 63
Table B3: Antimalarial market composition, across urban/rural location
survey:*
Urban, N= 1,029
Rural, N=472
Public
Health
Facility
Community
Health Worker
Facility
ALL
Public / NotFor-Profit
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General
Retailer
ALL
Private
%
%
%
%
%
%
%
%
%
5.6
0.5
2.6
8.7
25.4
16.0
41.0
8.9
91.3
(4.5, 6.8)
(0.3, 1.2)
(1.9, 3.4)
(7.1, 10.5)
(23.6, 27.3)
(11.3, 22.2)
(35.4, 46.8)
(6.3, 12.6)
(89.5, 92.9)
16.8
2.6
4.5
23.9
14.0
4.1
18.3
39.6
76.1
(12.6, 22.0)
(1.0, 6.3)
(2.3, 8.9)
(17.9, 31.2)
(10.6, 18.2)
(2.1, 7.9)
(12.8, 25.7)
(28.3, 52.2)
(68.8, 82.1)
www.ACTwatch.info
Page 64
Table B4a: Price of tablet formulation antimalarials, by outlet type, across urban/rural location
Private
For-Profit
Facility
Registered Pharmacy
General Retailer
ALL
Private
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
Urban
$2.25
[1.50-4.51] (530)
$3.38
[1.69-5.63] (1,961)
$2.25
[1.35-4.51] (1,230)
$2.82
[1.13-5.63] (48)
$2.70
[1.35-4.73] (3,769)
Rural
$1.69
[1.13-3.38] (125)
$1.80
[1.13-3.94] (154)
$1.35
[1.13-2.93] (202)
$1.35
[1.13-1.69] (36)
$1.58
[1.13-2.82] (517)
Urban
$1.69
[1.13-3.38] (383)
$1.69
[1.13-2.82] (1,017)
$1.69
[1.13-2.25] (816)
$1.35
[1.13-2.25] (38)
$1.69
[1.13-2.70] (2,254)
Rural
$1.69
[1.13-2.25] (93)
$1.35
[1.13-1.69] (99)
$1.13
[1.13-1.58] (145)
$1.35
[1.13-1.69] (35)
$1.35
[1.13-1.69] (372)
Urban
$5.63
[5.07-5.86] (10)
$5.63
[5.07-6.08] (74)
$5.07
[4.51-6.76] (16)
$9.91
[8.56-11.26] (2)
$5.63
[5.07-7.88] (102)
Rural
$6.20
[5.07-6.20] (2)
$4.73
[4.51-4.73] (2)
$6.76
[3.94-7.88] (3)
-
$6.20
[4.73-6.76] (7)
Urban
$1.69
[1.13-2.25] (342)
$1.35
[1.13-1.80] (802)
$1.58
[1.13-2.03] (682)
$1.13
[1.13-1.50] (34)
$1.69
[1.13-2.25] (1,860)
Rural
$1.69
[1.13-2.25] (91)
$1.13
[1.13-1.69] (87)
$1.13
[1.13-1.35] (136)
$1.35
[1.13-1.69] (35)
$1.13
[1.13-1.69] (349)
Urban
$1.69
[1.13-2.25] (282)
$1.35
[1.13-2.03] (708)
$1.58
[1.13-2.25] (609)
$1.13
[1.13-1.69] (29)
$1.69
[1.13-2.25] (1,628)
Rural
$1.50
[1.13-2.03] (78)
$1.13
[1.13-1.69] (76)
$1.13
[1.13-1.35] (116)
$1.35
[1.13-1.69] (32)
$1.13
[1.13-1.69] (302)
Any ACT
Artesunate Sulfadoxine Pyrimethamine (ASSP)
QA ACT with ‘green leaf’ logo
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Page 65
Private
For-Profit
Facility
Registered Pharmacy
General Retailer
ALL
Private
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
$1.69
$1.35
$1.50
$1.13
$1.35
Urban
[1.13-2.25]
(59)
[1.13-1.80]
(94)
[1.13-1.69]
(72)
[1.13-1.35]
(5)
[1.13-1.80] (230)
Rural
$1.69
[1.13-2.25] (12)
$1.13
[1.13-1.35] (11)
$1.13
[0.90-1.35] (20)
$1.69
[1.69-1.69] (3)
$1.13
[1.01-1.69] (46)
Urban
$1.69
[1.13-2.25] (323)
$1.35
[1.13-1.80] (725)
$1.50
[1.13-1.80] (651)
$1.13
[1.13-1.50] (34)
$1.58
[1.13-2.25] (1,733)
Rural
$1.69
[1.13-2.25] (87)
$1.13
[1.13-1.69] (84)
$1.13
[1.13-1.35] (130)
$1.35
[1.13-1.69] (35)
$1.13
[1.13-1.69] (336)
Urban
$4.51
[3.38-5.68] (188)
$5.07
[3.38-9.12] (1,159)
$4.73
[3.83-7.88] (548)
$6.76
[3.38-11.26] (14)
$4.73
[3.38-7.88] (1,909)
Rural
$3.94
[3.15-5.07] (34)
$3.94
[3.38-5.07] (67)
$3.94
[3.15-5.41] (66)
$3.94
$3.94
[3.15-5.07] (168)
Urban
$0.79
[0.56-1.35] (71)
$0.79
[0.56-1.69] (428)
$0.56
[0.56-1.13] (392)
$0.34
[0.34-0.51] (47)
$0.56
[0.56-1.13] (938)
Rural
$0.56
[0.34-0.56] (26)
$0.56
[0.45-0.84] (52)
$0.56
[0.45-0.68] (89)
$0.34
[0.34-0.45] (148)
$0.39
[0.34-0.56] (315)
Urban
$4.73
[2.37-7.10] (10)
$3.78
[3.31-4.73] (46)
$3.78
[2.37-4.73] (22)
$1.14
$3.78
[2.37-4.73] (79)
QA AL
Non-quality-assured ACT (non-QA ACT)
(1)
Quinine
(1)
$7.10
$3.78
$4.73
$4.73
[2.37-7.10] (3)
[2.84-4.73] (5)
[4.73-4.73] (8)
[3.31-4.73] (16)
73 any ACT tablets, 47 artemether lumefantrine tablets, 2 artesunate sulfadoxine pyrimethamine tablets, 46 QA ACT tablets, 39 QA ACT with AMFm logo tablets, 6 QA ACT without AMFm logo tablets,
41 QA artemether lumefantrine tablets, 27 non-QA ACT tablets, 7 sulfadoxine pyrimethamine tablets, 1 quinine tablet.
Rural
www.ACTwatch.info
Page 66
Table B4b: Price of pre-packaged antimalarials, by outlet type, across urban/rural location
Private
For-Profit
Facility
Median price of one prepackaged therapy:
Registered Pharmacy
ALL
Private
General Retailer
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
$1.69
$1.13
$1.13
$1.13
$1.13
Adult QA AL
Urban
Rural
[1.13-1.69]
(185)
$1.13
[1.13-1.69]
[1.13-1.69]
(404)
$1.13
(55)
[1.13-1.35]
[1.13-1.69]
(382)
$1.13
(48)
[1.13-1.13]
[1.13-1.13]
(19)
[1.13-1.69] (990)
$1.13
(78)
[1.13-1.69]
$1.13
(23)
[1.13-1.35] (204)
Pediatric QA AL*
Urban
Rural
$0.68
[0.56-1.13]
$0.56
(49)
$0.56
[0.56-1.13]
[0.45-0.90]
$0.56
(147)
$0.56
(16)
[0.34-0.56]
[0.56-0.90]
$0.56
(116)
$0.56
(14)
[0.56-0.68]
(15)
[0.56-1.13]
$0.56
(6)
[0.56-1.13] (318)
-
$0.56
-
[0.56-0.90] (45)
*QA AL is the pre-packaged regimen appropriate for a child under age five.
27 adult QA AL, 5 pediatric QA AL
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Page 67
Table B5: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type, across urban/rural location
Public
Health
Facility
%
(95% CI)
ALL
Public / Not- ForProfit**
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
Urban N=171
Rural N=300
Urban N=212
Rural N=361
Urban
96.2
(93.9, 97.6)
Rural
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=285
Rural N=90
Urban N=443
Rural N=47
Urban N=457
Rural N=99
Urban N=124
Rural N=281
Urban N=1,309
Rural N=517
Urban N=1,521
Rural N=878
91.1
(83.1, 95.5)
79.1
(70.6, 85.7)
80.2
(76.6, 83.4)
21.5
(18.3, 25.1)
18.2
(15.1, 21.9)
0.0
-
33.0
(29.6, 36.6)
92.4
(85.4, 96.2)
91.0
(77.7, 96.7)
69.5
(40.0, 88.6)
55.1
(44.0, 65.8)
13.4
(6.4, 25.9)
7.5
(3.9, 13.9)
0.0
-
10.7
(7.1, 15.8)
Urban N=170
Rural N=300
Urban N=211
Rural N=360
Urban N=285
Rural N=90
Urban N=443
Rural N=47
Urban N=456
Rural N=99
Urban N=122
Rural N=281
Urban N=1,306
Rural N=517
Urban N=1,517
Rural N=877
Urban
70.6
(65.6, 75.2)
62.7
(54.2, 70.5)
66.2
(61.5, 70.6)
8.0
(6.2, 10.4)
6.4
(4.7, 8.6)
0.0
-
22.5
(20.0, 25.2)
25.8
(23.4, 28.3)
Rural
54.1
(48.4, 59.8)
38.2
(21.5, 58.3)
44.8
(34.5, 55.6)
10.8
(4.9, 22.0)
2.7
(0.9, 7.8)
0.0
-
8.1
(5.1, 12.4)
14.6
(10.6, 19.9)
Urban N=170
Rural N=300
Urban N=210
Rural N=361
Urban N=285
Rural N=90
Urban N=443
Rural N=47
Urban N=456
Rural N=99
Urban N=123
Rural N=280
Urban N=1,307
Rural N=516
Urban N=1,517
Rural N=877
Urban
61.8
(54.0, 69.0)
44.8
(38.7, 51.1)
30.8
(27.4, 34.4)
15.8
(12.3, 20.0)
14.2
(12.0, 16.6)
0.0
-
16.7
(14.7, 18.9)
18.9
(17.3, 20.7)
Rural
72.7
(65.0, 79.3)
55.7
(35.4, 74.3)
24.3
(15.0, 36.9)
4.4
(1.1, 16.7)
4.8
(2.0, 10.6)
0.0
-
5.0
(2.9, 8.5)
16.1
(11.9, 21.3)
Urban N=170
Rural N=299
Urban N=210
Rural N=360
Urban N=284
Rural N=90
Urban N=443
Rural N=47
Urban N=456
Rural N=99
Urban N=123
Rural N=280
Urban N=1,305
Rural N=516
Urban N=1,515
Rural N=876
Urban
0.2
(0.1, 0.5)
0.1
(0.0, 0.3)
0.6
(0.3, 1.5)
1.4
(0.6, 3.4)
0.0
-
0.0
-
0.3
(0.2, 0.6)
0.3
(0.2, 0.6)
Rural
0.0
-
0.4
(0.1, 2.3)
0.0
-
0.0
-
0.0
-
0.0
-
0.0
-
0.1
(0.0, 0.5)
Proportion of outlets***
stocking
Any malaria blood testing
Microscopic blood tests
Rapid diagnostic tests (RDTs)
Checkmark RDTs
*** Results in this table are derived using responses captured among outlets with blood testing information. 6 antimalarial-stocking outlets had missing information about both availability of microscopy and
availability of RDTs. 18 antimalarial-stocking outlets had partial information about blood testing availability and are included in the denominator of the indicator “any blood testing available.”
www.ACTwatch.info
Page 68
Table B7: Price of malaria blood testing, by outlet type, across urban/rural location
Private
For-Profit
Facility
consumers:*
Registered Pharmacy
ALL
Private
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
$1.13
$1.13
$1.13
$1.13
[1.13-1.69] (222)
[1.13-1.69] (50)
[1.13-1.13] (27)
[1.13-1.69] (299)
$0.56
$0.56
$0.45
$0.56
[0.56-1.13] (41)
[0.45-0.56] (5)
[0.45-1.13] (3)
[0.56-1.13] (49)
$1.13
$1.13
$1.13
$1.13
Adult
Urban
Rural
Child under age five
Urban
[0.56-1.69]
Rural
(222)
$0.56
[0.56-0.56]
[1.13-1.13]
(50)
$0.56
(41)
[0.45-0.56]
[1.13-1.13]
(27)
$0.45
(5)
[0.45-1.13]
[0.56-1.69] (299)
$0.56
(3)
[0.56-0.90] (49)
Adult
Urban
$1.13
[1.13-1.69]
Rural
$1.13
(109)
$1.13
[0.56-1.13]
[1.13-1.13]
$1.13
(53)
$0.96
(25)
[0.79-1.13]
[1.13-1.69]
$1.13
(54)
$0.56
(2)
[0.56-1.13]
[1.13-1.69] (216)
$1.13
(5)
[0.56-1.13] (32)
Child under five
Urban
$1.13
[1.13-1.69]
Rural
$1.13
(108)
$1.13
[0.56-1.13] (25)
[1.13-1.13]
$1.13
(51)
$0.73
[0.56-0.90] (2)
$1.13
(54)
[1.13-1.69] (213)
$0.56
[0.56-1.13] (5)
$1.13
[0.56-1.13] (32)
[1.13-1.13]
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Page 69
Table B7: Price of malaria blood testing, by outlet type, across urban/rural location
Private
For-Profit
Facility
Median [IQR]
Median price excluding
fees:**
Registered Pharmacy
ALL
Private
Median [IQR]
Median [IQR]
Median [IQR]
$0.17
$1.13
$0.79
$0.68
(1)
[0.56-1.69] (12)
[0.56-1.13] (20)
[0.56-1.13] (33)
-
$0.90
$0.45
$0.45
-
(1)
(1)
[0.45-0.45] (2)
$0.17
$0.68
Adult
Urban
Rural
Child under five
Urban
(1)
Rural
[0.56-1.69]
$0.79
(11)
[0.56-1.13]
$0.68
(20)
[0.56-1.13] (32)
-
$0.90
$0.45
$0.45
-
(1)
(1)
[0.45-0.45] (2)
* Total price to the consumer including consultation and/or service fees.
** Price to the consumer for an RDT excluding consultation and/or service fees.
Microscopic blood testing price information was not available for all outlets. There were 6 outlets with missing or “don’t know” responses.
RDT price information was not available (missing or “don’t know” response) for: 31 adult RDTs and 34 child RDTs in median price to consumers and 244 adult RDTs and 245
child RDTs in median price excluding fees.
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Page 70
Table B8a: Antimalarial market share, urban
Public
Health
Facility
TOTAL
Public
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
TOTAL
Private
ANTI-MALARIAL
TOTAL***
%
%
%
%
%
%
%
%
5.7
7.3
9.6
32.7
20.4
1.1
63.8
71.2
Artesunate Sulfadoxine Pyrimethamine
(ASSP)
DHAPPQ
5.6
6.9
8.3
25.0
17.1
0.9
51.3
58.2
0.0
0.0
0.1
0.3
0.1
0.0
0.5
0.5
0.1
0.4
0.8
5.8
2.4
0.2
9.2
9.5
as a percentage of all AETDs sold/
distributed:*
1. Any ACT

5.6
6.8
6.7
20.6
15.3
0.5
43.0
49.8
3.4
4.1
5.1
16.8
13.7
0.4
36.1
40.2
2.3
2.7
1.5
3.8
1.6
0.0
6.9
9.6
0.1
0.5
3.0
12.1
5.1
0.6
20.8
21.3
5.6
7.2
8.7
25.7
17.7
0.8
52.9
60.2
0.9
1.0
1.7
14.8
8.8
1.0
26.3
27.2
0.7
0.7
1.5
13.8
8.3
1.0
24.5
25.2
Oral Quinine
0.0
0.1
0.0
0.3
0.1
0.0
0.4
0.5
Quinine IV/IM
0.1
0.2
0.1
0.3
0.1
0.0
0.4
0.6
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.1
0.2
0.4
0.7
0.2
0.0
1.4
1.6
0.1
0.1
0.1
0.0
0.1
0.0
0.2
0.3
0.0
0.1
0.3
0.7
0.2
0.0
1.1
1.3
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.2
0.4
0.5
1.0
0.3
0.0
1.8
2.1
6.7
8.5
11.7
48.2
29.5
2.1
91.5
100.0
* A total of 30,012.7 AETDs were reportedly sold or distributed in the previous seven days. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and drug category.
www.ACTwatch.info
Page 71
Table B8b: Antimalarial market share, rural
distributed:*
1. Any ACT
Public
Health
Facility
TOTAL
Public
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
TOTAL
Private
ANTIMALARIAL
TOTAL***
%
%
%
%
%
%
%
%
15.0
21.3
9.3
4.4
22.5
7.4
43.6
64.9
(ASSP)
DHAPPQ
15.0
21.1
8.5
3.9
20.7
7.3
40.4
61.5
0.0
0.0
0.1
0.0
0.1
0.0
0.1
0.1
0.0
0.2
0.7
0.5
1.5
0.1
2.7
2.9
15.0
20.5
8.0
3.6
20.4
7.3
39.2
59.7
5.9
7.8
7.2
2.7
15.5
5.6
30.9
38.8
9.1
12.6
0.8
0.9
4.9
1.7
8.3
20.9
0.0
0.9
1.4
0.7
2.2
0.1
4.3
5.2
13.9
19.6
8.8
4.1
19.9
7.1
39.9
59.5
5.8
7.0
2.1
3.4
12.4
9.6
27.6
34.6
4.8
4.9
1.9
3.4
11.9
9.3
26.5
31.3
Oral Quinine
0.8
1.8
0.0
0.0
0.1
0.0
0.2
1.9
Quinine IV/IM
0.3
0.3
0.2
0.0
0.2
0.0
0.5
0.8
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.2
0.2
0.1
0.0
0.1
0.0
0.3
0.5
0.1
0.1
0.0
0.0
0.0
0.0
0.0
0.1
0.0
0.1
0.1
0.0
0.1
0.0
0.3
0.3
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.6
0.3
0.0
0.4
0.0
0.7
1.3
21.0
28.6
11.6
7.8
35.1
17.0
71.4
100.0
* A total of 5,632.6 AETDs were reportedly sold or distributed in the previous seven days. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and drug category.
www.ACTwatch.info
Page 72
Table B9a: Antimalarial market share across outlets, urban
distributed:*
1. Any ACT
Public
Health
Facility
TOTAL
Public / Not ForProfit**
Private
For-Profit
Facility
Registered Pharmacy
Unregistered
Pharmacy
General Retailer
TOTAL
Private
%
%
%
%
%
%
%
85.3
86.4
81.9
67.9
69.2
53.0
69.8
(ASSP)
DHAPPQ
84.3
81.6
70.8
51.8
58.0
42.0
56.0
0.0
0.0
0.6
0.6
0.4
0.7
0.5
0.8
4.5
7.1
12.0
8.1
8.3
10.0
84.2
80.4
56.7
42.7
51.9
22.6
47.0
50.2
48.4
43.9
34.8
46.6
20.3
39.5
33.9
32.0
12.8
7.9
5.3
2.2
7.5
1.1
6.0
25.3
25.2
17.3
30.4
22.8
84.4
85.0
73.8
53.4
60.1
38.7
57.9
13.4
11.2
14.6
30.6
29.9
47.0
28.7
10.0
8.2
12.7
28.6
28.1
46.4
26.8
Oral Quinine
0.7
0.7
0.4
0.6
0.4
0.0
0.5
Quinine IV/IM
2.2
1.9
0.8
0.5
0.2
0.0
0.4
0.0
0.0
0.1
0.0
0.0
0.0
0.0
1.3
2.4
3.3
1.5
0.8
0.0
1.5
1.3
1.0
0.7
0.0
0.3
0.0
0.2
0.1
1.4
2.4
1.5
0.5
0.0
1.2
0.0
0.0
0.3
0.0
0.0
0.0
0.0
3.5
4.3
4.1
2.0
1.1
0.0
1.9
100.0
100.0
100.0
100.0
100.0
100.0
100.0
*
AETDs reportedly sold or distributed in the previous seven days: 1,966.9 public health facility; 468.5 private-not-for-profit HF; 3,334.2 private for-profit HF; 15,226.0 Registered Pharmacy; 8665.3 Unregistered
Pharmacy; 337.7 general retailer. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and drug category.
A total of 5,313 antimalarials were audited. Of these, 230 audited antimalarials were not included in market share calculations due to incomplete or inconsistent information, including the following number of
antimalarials by outlet type: 19 public health facilities; 1 private not-for profit facilities; 63 private for-profit facilities; 49 registered pharmacies; 91 unregistered pharmacies; 7 general retailers.
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Page 73
Table B9b: Antimalarial market share across outlets, rural
distributed:*
1. Any ACT
Public
Health
Facility
TOTAL
Private
For-Profit
Facility
Registered Pharmacy
Unregistered
Pharmacy
General Retailer
TOTAL
Private
%
%
%
%
%
%
%
71.7
74.6
80.5
56.0
64.3
43.4
61.0
(ASSP)
DHAPPQ
71.7
73.8
73.4
49.9
59.0
43.0
56.5
0.0
0.0
0.8
0.0
0.2
0.0
0.2
0.0
0.8
5.9
5.8
4.3
0.4
3.8
71.7
71.6
68.8
46.4
58.1
43.0
55.0
QA ACT without the ‘green leaf’
logo
28.3
27.4
62.2
34.6
44.1
32.7
43.3
43.4
44.1
6.6
11.8
14.0
10.3
11.7
0.0
3.0
11.7
9.5
6.2
0.4
6.1
66.3
68.5
76.2
52.3
56.9
41.7
55.9
27.6
24.5
18.5
43.9
35.4
56.6
38.6
22.7
17.0
16.3
43.3
34.0
54.7
37.1
Oral Quinine
3.6
6.2
0.3
0.2
0.4
0.0
0.2
Quinine IV/IM
1.2
1.2
1.6
0.3
0.7
0.0
0.6
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.8
0.8
1.0
0.1
0.3
0.0
0.4
0.7
0.5
0.0
0.0
0.0
0.0
0.0
0.1
0.3
1.0
0.1
0.3
0.0
0.4
0.0
0.0
0.0
0.0
0.0
0.0
0.0
2.0
2.0
2.7
0.5
1.0
0.0
1.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
*
5632.6 AETDs reportedly sold or distributed in the previous seven days: 916.9 public health facility; 72.5 CHW; 370.5 private-not-for-profit HF; 743.2 private for-profit HF; 562.5 Registered Pharmacy; 2,111.8
Unregistered Pharmacy; 855.2 general retailer. See Annex 11 for a description of AETD calculation and Annex 12 for AETD numbers by outlet type and drug category.
A total of 1,338 antimalarials were audited. Of these, 95 audited antimalarials were not included in market share calculations due to due to incomplete or inconsistent information, including the following number
of antimalarials by outlet type: 8 public health facility; 1 community health worker;17 private for-profit; 12 registered pharmacy; 32 unregistered pharmacy; 25 general retailer.
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Page 74
Table B12: Provider case management knowledge and practices, by outlet type, across urban/rural location
Would refer a 2 year old child with
symptoms of severe malaria to a
health facility
Public
Health
Facility
%
(95% CI)
ALL
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
-
Urban N=16
Rural N=43
-
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=443
Rural N=47
Urban N=451
Rural N=99
Urban N=124
Rural N=279
Urban N=1,018
Rural N=425
Urban N=1,034
Rural N=468
90.6
(87.5, 93.0)
90.6
(79.9, 95.9)
86.0
(83.1, 88.5)
80.2
(68.8, 88.1)
87.7
(84.6, 90.2)
88.8
(81.4, 93.4)
87.1
(84.9, 89.1)
86.8
(80.8, 91.1)
87.5
(85.3, 89.5)
87.0
(81.7, 91.0)
Yes, would refer to health facility
Urban
NA
Rural
NA
Would recommend that a client
with a negative malaria blood test
take an antimalarial
100.0
89.1
(77.7, 95.0)
NA
NA
Urban N=166
Rural N=291
Urban N=208
Rural N=353
Urban N=278
Rural N=82
Urban N=395
Rural N=34
Urban N=378
Rural N=79
Urban N=55
Rural N=88
Urban N=1,106
Rural N=283
Urban N=1,314
Rural N=636
26.5
(22.2, 31.3)
17.5
(12.8, 23.5)
32.7
(27.0, 39.0)
15.2
(8.5, 25.6)
31.2
(27.7, 34.9)
28.8
(19.9, 39.7)
30.4
(27.2, 33.8)
24.1
(13.2, 39.8)
31.2
(27.6, 35.1)
24.9
(15.2, 37.8)
12.5
(8.9, 17.3)
10.2
(5.6, 17.9)
29.3
(27.2, 31.6)
20.5
(15.9, 26.0)
29.7
(27.5, 32.0)
18.6
(13.9, 24.5)
6.1
(3.9, 9.4)
3.7
(1.8, 7.6)
4.5
(2.9, 6.9)
2.6
(1.5, 4.6)
6.6
(4.2, 10.0)
4.4
(1.6, 11.7)
2.8
(2.0, 4.0)
0.0
-
1.5
(0.9, 2.4)
5.0
(1.6, 14.5)
1.8
(0.7, 4.7)
11.3
(4.1, 27.7)
3.4
(2.6, 4.5)
7.1
(3.7, 13.1)
3.5
(2.7, 4.6)
5.5
(3.2, 9.4)
Urban N=46
Rural N=57
Urban N=63
Rural N=67
Urban N=103
Rural N=27
Urban N=119
Rural N=7
Urban N=125
Rural N=21
Urban N=8
Rural N=16
Urban N=355
Rural N=71
Urban N=418
Rural N=138
98.3
(94.8, 99.4)
98.9
(93.5, 99.8)
93.8
(87.9, 97.0)
96.2
(83.0, 99.2)
86.8
(82.2, 90.3)
95.9
(82.0, 99.2)
90.9
(86.8, 93.8)
83.9
(48.9, 96.6)
84.0
(80.5, 87.0)
96.2
(83.7, 99.2)
100.0
56.3
(32.1, 77.7)
86.6
(83.3, 89.3)
84.2
(74.3, 90.7)
87.4
(84.0, 90.2)
87.3
(79.7, 92.4)
Yes – sometimes
Urban
Rural
Yes – always
Urban
Rural
Circumstances cited for
recommending antimalarial
treatment to a client who tested
negative for malaria:*
Patient has signs and symptoms
of malaria.
Urban
Rural
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Page 75
Table B12: Provider case management knowledge and practices, by outlet type, across urban/rural location
Public
Health
Facility
%
(95% CI)
ALL
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
26.5
17.0
(16.1, 40.3)
(10.2, 26.8)
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
7.8
11.7
16.8
-
12.0
12.5
(5.5, 11.0)
(8.0, 16.9)
(12.9, 21.5)
-
(9.3, 15.2)
(9.9, 15.7)
Provider doesn't trust the test
results.
Urban
Rural
11.7
15.5
6.6
8.4
11.5
36.4
17.0
16.6
(5.6, 22.7)
(5.6, 36.4)
(1.8, 21.2)
(1.4, 37.9)
(2.3, 42.1)
(9.8, 75.1)
(7.5, 34.0)
(8.6, 29.8)
4.5
1.9
4.4
10.2
8.5
6.1
7.0
6.4
(1.6, 11.9)
(0.6, 5.6)
(2.4, 7.9)
(7.3, 14.0)
(6.2, 11.6)
(1.9, 17.9)
(5.2, 9.4)
(4.8, 8.5)
12.6
6.3
2.4
8.4
-
-
1.0
2.4
(6.7, 22.6)
(2.8, 13.5)
(0.4, 13.1)
(1.4, 37.9)
-
-
(0.2, 4.5)
(1.0, 5.5)
90.6
84.5
87.2
83.2
76.2
82.8
81.7
82.0
(82.9, 95.1)
(74.2, 91.1)
(79.6, 92.3)
(72.8, 90.1)
(61.6, 86.5)
(63.7, 93.0)
(72.4, 88.3)
(73.0, 88.5)
70.6
61.8
89.0
100.0
85.9
92.5
89.2
82.0
(42.9, 88.5)
(33.5, 83.9)
(71.3, 96.3)
-
(60.1, 96.1)
(67.2, 98.7)
(77.0, 95.3)
(63.5, 92.3)
When the patient asks for
antimalarial treatment.
Urban
Rural
Other (all other reasons)
Urban
Rural
Provider questions were administered to one staff member working in each outlet eligible for a full interview (current/recent antimalarial-stocking outlets or outlets providing malaria blood testing).
* No providers were missing information on circumstances for recommending antimalarials to clients who tested negative for malaria.
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Page 76
Table B13: Provider antimalarial treatment knowledge and practices, by outlet type, across urban/rural location
Public
Health
Facility
%
(95% CI)
ALL
Public / Not ForProfit*
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
Urban N=171
Rural N=300
Urban N=212
Rural N=361
99.5
(98.8, 99.8)
98.2
(96.0, 99.2)
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
Urban N=285
Rural N=90
Urban N=444
Rural N=48
Urban N=458
Rural N=99
Urban N=125
Rural N=283
Urban N=1,312
Rural N=520
Urban N=1,524
Rural N=881
95.7
(93.0, 97.4)
96.3
(92.7, 98.2)
93.3
(91.9, 94.5)
91.1
(82.9, 95.6)
96.1
(93.6, 97.7)
96.5
(89.3, 98.9)
91.1
(89.1, 92.8)
90.4
(82.2, 95.1)
33.3
(25.0, 42.6)
27.3
(18.9, 37.5)
82.4
(77.5, 86.5)
51.2
(40.6, 61.8)
83.5
(79.0, 87.2)
61.1
(49.7, 71.4)
97.1
(94.8, 98.5)
95.1
(89.7, 97.7)
83.5
(75.4, 89.3)
91.3
(84.6, 95.2)
87.2
(84.9, 89.2)
89.7
(82.8, 94.1)
89.6
(87.5, 91.5)
93.2
(84.7, 97.2)
86.3
(83.8, 88.5)
85.7
(76.9, 91.6)
18.6
(11.2, 29.5)
16.5
(11.5, 23.3)
75.4
(69.3, 80.7)
43.4
(33.8, 53.5)
76.1
(70.1, 81.2)
53.8
(43.5, 63.9)
87.7
(82.4, 91.5)
87.9
(82.9, 91.6)
78.4
(72.0, 83.6)
79.5
(68.7, 87.2)
71.6
(68.6, 74.4)
77.5
(64.4, 86.8)
81.3
(78.8, 83.6)
77.5
(62.7, 87.6)
73.3
(70.3, 76.1)
76.2
(63.3, 85.6)
9.5
(5.8, 15.2)
10.4
(6.4, 16.6)
62.8
(57.6, 67.7)
35.4
(26.6, 45.4)
64.1
(59.0, 68.8)
45.0
(35.9, 54.5)
96.7
(94.1, 98.1)
96.7
(92.9, 98.5)
92.9
(87.2, 96.1)
94.6
(89.7, 97.2)
91.3
(89.1, 93.1)
82.5
(73.8, 88.8)
95.6
(93.9, 96.8)
86.8
(77.5, 92.6)
89.1
(87.5, 90.5)
81.6
(73.8, 87.5)
37.7
(26.1, 51.0)
24.7
(13.3, 41.4)
81.7
(75.9, 86.3)
46.4
(33.9, 59.3)
82.6
(77.0, 87.1)
56.9
(44.1, 68.9)
90.5
(86.0, 93.7)
97.7
(95.0, 99.0)
92.1
(89.2, 94.2)
91.3
(86.5, 94.5)
89.0
(86.8, 90.9)
81.8
(71.9, 88.8)
96.5
(95.0, 97.6)
93.7
(79.2, 98.3)
87.5
(85.3, 89.4)
77.6
(68.5, 84.7)
29.1
(18.9, 42.0)
18.2
(9.3, 32.7)
79.0
(72.8, 84.1)
41.5
(30.0, 54.1)
80.1
(74.4, 84.7)
52.4
(40.5, 64.0)
Correctly state the national first-line
treatment for uncomplicated malaria
Urban
Rural
Correctly state the first-line dosing
regimen for an adult
Urban
Rural
regimen for a child
Urban
Rural
Report an ACT as the most effective
antimalarial medicine for an adult
Urban
Rural
Report an ACT as the most effective
antimalarial medicine for a child
Urban
Rural
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Page 77
Table B13: Provider antimalarial treatment knowledge and practices, by outlet type, across urban/rural location
Public
Health
Facility
%
(95% CI)
ALL
Public / Not ForProfit*
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
99.4
(98.7, 99.7)
97.8
(93.6, 99.3)
91.3
(87.2, 94.2)
98.4
(95.5, 99.4)
97.5
(94.7, 98.8)
98.4
(93.5, 99.6)
94.0
(91.7, 95.7)
96.8
(91.0, 98.9)
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
93.6
(91.7, 95.1)
91.5
(85.0, 95.3)
94.4
(92.3, 96.0)
90.7
(78.3, 96.4)
86.0
(84.0, 87.8)
84.7
(73.3, 91.8)
36.1
(25.7, 48.0)
21.3
(10.2, 39.2)
80.6
(75.5, 84.8)
46.4
(32.8, 60.6)
81.5
(76.6, 85.5)
57.7
(43.2, 71.1)
88.7
(86.7, 90.5)
84.4
(75.9, 90.3)
95.3
(93.0, 96.9)
90.9
(77.9, 96.6)
84.0
(81.1, 86.5)
77.7
(65.5, 86.5)
28.0
(17.9, 40.9)
16.8
(8.5, 30.5)
77.0
(71.6, 81.7)
41.1
(29.4, 53.9)
78.4
(73.5, 82.7)
53.2
(40.1, 66.0)
Report an ACT as the antimalarial he/she
most commonly recommends for adults
Urban
Rural
Report an ACT as the antimalarial he/she
most commonly recommends for children
Urban
Rural

Numbers of providers (N) in this table are the total number of providers eligible for table indicators.
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Page 78
Results Section C: Core Indicators by Type of Public Health Facility
Table C1: Availability of antimalarials, among screened outlets, by type of public health facility
Any antimalarial at the time of
survey visit
Any ACT
QA ACT AL
QA ACT with the ‘green leaf’
logo
leaf’ logo
Non-quality-assured ACT (nonQA ACT)
malaria
ALL
Public Health Facilities
Hospital
Public Health Centre
Public Dispensary
%
(95% CI)
N=44
%
(95% CI)
N=152
%
(95% CI)
N=289
%
(95% CI)
87.5
98.9
90.7
92.5
(69.9, 95.5)
(97.5, 99.5)
(87.4, 93.3)
(89.5, 94.7)
85.3
81.8
74.0
77.2
(68.9, 93.9)
(75.1, 87.0)
(68.3, 78.9)
(72.7, 81.2)
85.3
81.8
74.0
77.2
(68.9, 93.9)
(75.1, 87.0)
(68.3, 78.9)
(72.7, 81.2)
85.3
81.8
73.8
77.1
(68.9, 93.9)
(75.1, 87.0)
(68.1, 78.8)
(72.6, 81.1)
85.3
81.8
73.8
77.1
(68.9, 93.9)
(75.1, 87.0)
(68.1, 78.8)
(72.6, 81.1)
44.3
24.1
26.0
27.5
(31.0, 58.5)
(18.0, 31.6)
(20.1, 32.8)
(22.1, 33.7)
69.9
69.3
61.7
64.6
(54.6, 81.7)
(61.3, 76.4)
(54.5, 68.3)
(58.8, 69.9)
11.2
2.5
0.9
2.5
(6.3, 19.1)
(1.3, 4.7)
(0.5, 1.6)
(1.7, 3.5)
71.1
77.1
66.6
69.8
(56.1, 82.5)
(70.0, 82.9)
(60.4, 72.3)
(64.2, 74.9)
19.0
12.4
13.6
13.9
(11.9, 28.9)
(7.8, 19.1)
(8.9, 20.4)
(9.7, 19.6)
76.6
84.1
69.7
74.2
(61.1, 87.2)
(78.6, 88.4)
(63.5, 75.3)
(69.5, 78.4)
N=485
* The denominator includes outlets that met screening criteria for a full interview. There were 10 outlets that did not complete the
interview (were not interviewed or completed a partial interview).
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Page 79
Table C2: Availability of antimalarials, among outlets stocking at least one antimalarial, by type of
public health facility
Any antimalarial at the time of
survey visit
Any ACT
QA ACT AL
QA ACT with the ‘green leaf’
logo
leaf’ logo
Non-quality-assured ACT (nonQA ACT)
malaria
ALL
Public Health Facilities
Hospital
Public Dispensary
%
(95% CI)
N=42
%
(95% CI)
N=147
%
(95% CI)
N=268
%
(95% CI)
100.0
100.0
100.0
100.0
-
-
-
-
97.4
82.7
81.5
83.5
(92.6, 99.1)
(76.0, 87.8)
(76.3, 85.8)
(79.6, 86.8)
97.4
82.7
81.5
83.5
(92.6, 99.1)
(76.0, 87.8)
(76.3, 85.8)
(79.6, 86.8)
97.4
82.7
81.3
83.4
(92.6, 99.1)
(76.0, 87.8)
(76.1, 85.6)
(79.5, 86.6)
97.4
82.7
81.3
83.4
(92.6, 99.1)
(76.0, 87.8)
(76.1, 85.6)
(79.5, 86.6)
50.6
24.4
28.6
29.8
(35.9, 65.2)
(18.2, 31.9)
(22.2, 36.0)
(24.0, 36.3)
79.8
70.1
68.0
69.8
(66.7, 88.6)
(62.1, 77.1)
(60.5, 74.6)
(64.0, 75.0)
12.8
2.5
1.0
2.7
(7.3, 21.5)
(1.3, 4.7)
(0.6, 1.8)
(1.9, 3.8)
81.2
77.9
73.4
75.5
(69.3, 89.2)
(70.8, 83.7)
(67.4, 78.7)
(70.1, 80.2)
21.7
12.5
15.0
15.0
(13.7, 32.5)
(7.9, 19.3)
(9.8, 22.4)
(10.5, 21.1)
87.5
85.0
76.8
80.2
(76.9, 93.6)
(79.5, 89.2)
(70.3, 82.2)
(75.6, 84.1)
N=457
* The denominator includes outlets that met screening criteria for a full interview. There were 9 outlets that did not complete the
interview (were not interviewed or completed a partial interview).
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Page 80
Table C5: Availability of malaria blood testing among antimalarial-stocking outlets*, by type of public
health facility
Proportion of outlets** that
stocked:
Hospital
Public Dispensary
%
(95% CI)
%
(95% CI)
%
(95% CI)
ALL
Public Health
Facilities
%
(95% CI)
N=43
N=150
N=278
N=471
100.0
100.0
90.5
94.1
N=43
N=150
(84.3, 94.4)
N=277
(90.1, 96.5)
N=470
100.0
88.3
42.5
60.9
N=43
(78.3, 94.1)
N=150
(37.1, 48.1)
N=277
(56.8, 64.9)
N=470
23.7
68.2
75.9
68.2
(15.4, 34.6)
(59.2, 76.1)
(69.1, 81.6)
(62.7, 73.3)
* Blood testing availability is reported among outlets that either had antimalarials in stock on the day of the survey or reportedly stocked
antimalarials in the previous 3 months.
** Results in this table are derived using responses captured among outlets with blood testing information. There were no antimalarialstocking outlet with missing information about both availability of microscopy and availability of RDTs, and 3 antimalarial-stocking
outlets had partial information about blood testing availability.
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Page 81
Table C12: Provider antimalarial treatment knowledge and practices, by type of public health facility
Hospital
Public Dispensary
%
(95% CI)
%
(95% CI)
%
(95% CI)
ALL
Public Health
Facilities
%
(95% CI)
N=43
N=150
N=278
N=471
100.0
97.3
99.1
98.7
-
(94.2, 98.7)
(97.7, 99.7)
(97.5, 99.3)
89.3
96.0
97.1
95.9
(58.6, 98.0)
(92.4, 97.9)
(95.2, 98.2)
(92.9, 97.7)
Correctly state the national firstline treatment for uncomplicated
malaria
regimen for:
An adult
75.7
88.9
89.4
87.8
(56.3, 88.3)
(83.8, 92.5)
(85.8, 92.2)
(84.4, 90.6)
Report an ACT as the most
effective antimalarial medicine for
Adults
Children
95.3
98.5
96.2
96.7
(87.2, 98.4)
(96.7, 99.3)
(93.2, 97.9)
(94.6, 98.0)
88.7
96.8
94.9
94.7
(77.3, 94.8)
(94.2, 98.3)
(91.8, 96.8)
(92.6, 96.3)
Report an ACT as the antimalarial
he/she most commonly
recommends for:
Adults
Children
97.9
98.6
98.5
98.5
(88.8, 99.6)
(96.9, 99.4)
(94.2, 99.6)
(96.3, 99.4)
91.3
98.8
98.9
98.0
(79.9, 96.5)
(97.2, 99.5)
(93.6, 99.8)
(95.7, 99.1)

At the time of the 2014 Kenya ACTwatch outlet survey, artemether lumefantrine was Kenya's first line treatment for uncomplicated
malaria.
Numbers of providers (N) in this table are the total number of providers eligible for table indicators. There were no providers with missing
information.
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Page 82
Results Section D: Core Indicators across Survey Round: 2010, 2011, 2014
Table D1: Availability of antimalarials, among all screened outlets, by outlet type, across survey round
Public
Health
Facility
%
(95% CI)
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
2010 N=426
2011 N=442
2014 N=485
2010 N=1,806
2011 N=837
2014 N=1,096
91.7
(84.7, 95.7)
96.8
(92.0, 98.8)
92.5
(89.5, 94.7)
ALL
Public
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
2010 N=365
2011 N=308
2014 N=453
2010 N=236
2011 N=263
2014 N=503
2010 N=477
2011 N=503
2014 N=572
2010 N=10,669
2011 N=9,424
2014 N=9,950
2010 N=12,901
2011 N=10,546
2014 N=11,580
2010 N=13,897
2011 N=11,383
2014 N=12,676
10.0
(6.3, 15.6)
52.5
(26.3, 77.5)
18.6
(14.2, 24.0)
62.5
(46.9, 75.9)
88.9
(81.3, 93.6)
73.3
(68.5, 77.6)
92.2
(86.2, 95.8)
98.4
(95.9, 99.4)
96.3
(94.2, 97.7)
88.1
(83.9, 91.3)
94.4
(91.1, 96.5)
93.2
(91.7, 94.4)
4.9
(3.4, 7.0)
5.3
(4.1, 6.9)
2.9
(2.1, 4.0)
10.0
(8.5, 11.7)
12.1
(10.7, 13.5)
10.7
(9.8, 11.7)
10.0
(8.5, 11.7)
16.6
(15.2, 18.1)
11.3
(10.4, 12.3)
81.4
(68.5, 89.8)
94.0
(89.6, 96.6)
77.2
(72.7, 81.2)
8.5
(5.1, 13.8)
51.1
(25.8, 75.9)
16.2
(12.2, 21.1)
35.6
(27.6, 44.4)
74.3
(66.9, 80.5)
67.9
(63.6, 71.8)
91.1
(85.8, 94.5)
93.7
(88.6, 96.6)
96.2
(94.1, 97.5)
41.1
(35.0, 47.5)
84.7
(77.1, 90.2)
85.8
(82.9, 88.3)
0.0
1.3
(0.7, 2.2)
0.8
(0.4, 1.4)
2.9
(2.4, 3.5)
7.6
(6.2, 9.1)
8.3
(7.3, 9.3)
3.9
(3.2, 4.6)
12.5
(11.1, 14.0)
8.8
(7.9, 9.8)
81.4
(68.5, 89.8)
94.0
(89.6, 96.6)
77.2
(72.7, 81.2)
8.4
(5.1, 13.6)
51.1
(25.8, 75.8)
16.2
(12.2, 21.1)
32.0
(24.4, 40.6)
73.3
(66.0, 79.6)
66.4
(62.2, 70.3)
89.1
(84.4, 92.5)
92.9
(87.3, 96.1)
94.2
(91.7, 96.0)
39.8
(34.2, 45.6)
83.3
(75.8, 88.9)
83.9
(81.1, 86.3)
0.0
1.3
(0.7, 2.2)
0.8
(0.4, 1.4)
2.8
(2.3, 3.4)
7.5
(6.2, 9.0)
8.1
(7.2, 9.1)
3.7
(3.1, 4.5)
12.4
(11.1, 13.9)
8.7
(7.8, 9.7)
80.4
(66.0, 89.6)
93.9
(89.5, 96.5)
77.1
(72.6, 81.1)
8.2
(5.0, 13.4)
51.0
(25.8, 75.7)
16.1
(12.2, 21.1)
23.3
(17.0, 31.2)
69.4
(62.2, 75.8)
61.2
(57.2, 65.2)
81.4
(76.8, 85.3)
89.7
(84.2, 93.4)
87.1
(84.8, 89.1)
29.1
(24.1, 34.6)
81.5
(73.8, 87.3)
78.5
(76.0, 80.8)
0.0
1.2
(0.7, 2.2)
0.8
(0.4, 1.3)
2.1
(1.7, 2.6)
7.2
(5.9, 8.8)
7.5
(6.7, 8.5)
3.1
(2.6, 3.8)
12.2
(10.9, 13.6)
8.2
(7.4, 9.1)
Any antimalarial at the time of survey visit
2010
2011
2014
Any ACT
2010
2011
2014
2010
2011
2014
2010
2011
2014
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Page 83
Public
Health
Facility
%
(95% CI)
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
1.2
(0.5, 2.7)
66.5
(53.9, 77.1)
27.5
(22.1, 33.7)
0.1
(0.1, 0.3)
35.9
(19.6, 56.2)
7.5
(5.1, 10.8)
80.0
(65.8, 89.3)
62.1
(49.7, 73.0)
64.6
(58.8, 69.9)
ALL
Public
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
8.4
(5.5, 12.6)
64.6
(57.6, 71.0)
53.9
(50.0, 57.7)
45.7
(32.6, 59.5)
89.5
(83.9, 93.3)
82.7
(80.5, 84.8)
9.1
(4.3, 18.5)
79.1
(71.0, 85.5)
71.0
(67.5, 74.2)
0.0
1.2
(0.7, 2.1)
0.6
(0.4, 1.1)
0.8
(0.5, 1.2)
7.0
(5.7, 8.5)
6.7
(6.0, 7.6)
0.7
(0.4, 1.0)
10.3
(8.9, 11.8)
6.8
(6.0, 7.7)
8.2
(4.9, 13.3)
33.4
(17.2, 54.6)
12.0
(8.8, 16.0)
17.6
(11.7, 25.8)
11.8
(7.6, 17.7)
14.9
(12.3, 18.1)
74.1
(68.2, 79.2)
17.2
(14.4, 20.2)
22.6
(18.0, 27.9)
6.9
(4.1, 11.4)
16.3
(14.1, 18.8)
0.0
0.2
(0.1, 0.4)
1.7
(1.2, 2.2)
0.7
(0.6, 1.0)
1.6
(1.4, 1.9)
2.7
(2.2, 3.4)
4.4
(3.5, 5.5)
2.4
(2.1, 2.8)
3.4
(1.9, 5.9)
6.1
(3.3, 11.0)
2.5
(1.7, 3.5)
0.9
(0.4, 1.9)
3.5
(1.5, 8.0)
2.6
(1.3, 5.2)
26.6
(19.5, 35.2)
29.3
(22.1, 37.7)
36.2
(33.0, 39.6)
90.5
(85.3, 94.0)
86.8
(80.8, 91.1)
84.4
(79.9, 88.1)
25.8
(18.3, 35.1)
37.3
(29.2, 46.2)
46.7
(40.3, 53.1)
0.0
0.1
(0.0, 0.2)
0.1
(0.0, 0.1)
2.1
(1.7, 2.5)
3.4
(2.7, 4.3)
4.5
(3.8, 5.2)
1.9
(1.5, 2.3)
3.4
(2.7, 4.3)
4.3
(3.7, 5.1)
87.3
(78.9, 92.7)
91.3
(85.5, 94.9)
69.8
(64.2, 74.9)
8.2
(5.5, 12.0)
49.5
(25.0, 74.3)
12.4
(9.3, 16.5)
52.0
(37.3, 66.4)
66.8
(60.2, 72.8)
38.1
(33.7, 42.7)
72.9
(67.3, 77.9)
83.4
(75.5, 89.1)
62.0
(57.9, 65.9)
80.0
(75.7, 83.7)
75.4
(67.5, 81.9)
65.6
(62.2, 68.8)
4.9
(3.4, 7.0)
4.5
(3.4, 5.9)
2.3
(1.6, 3.4)
9.3
(7.9, 10.9)
9.8
(8.7, 11.0)
7.2
(6.5, 8.1)
9.1
(7.7, 10.7)
14.3
(12.9, 15.7)
7.6
(6.9, 8.5)
QA ACT with “green leaf” logo
2010
2011
2014
QA ACT without “green leaf” logo
2010
2011
2014
2010
2011
2014
2010
2011
2014
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Page 84
Public
Health
Facility
%
(95% CI)
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
68.4
(56.8, 78.1)
55.4
(43.3, 66.9)
13.9
(9.7, 19.6)
6.6
(4.3, 9.9)
30.5
(15.9, 50.4)
3.1
(2.2, 4.2)
59.4
(50.9, 67.4)
72.7
(64.6, 79.5)
41.5
(36.1, 47.2)
ALL
Public
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
26.8
(19.1, 36.2)
37.0
(28.6, 46.3)
18.1
(15.7, 20.8)
31.0
(21.9, 41.8)
64.0
(52.9, 73.8)
50.8
(47.5, 54.1)
68.9
(61.2, 75.7)
53.9
(46.7, 61.0)
53.6
(50.1, 56.9)
3.3
(2.2, 5.0)
2.8
(2.1, 3.9)
1.8
(1.2, 2.6)
6.7
(5.3, 8.3)
6.5
(5.6, 7.5)
5.3
(4.7, 6.0)
6.7
(5.3, 8.3)
9.2
(8.0, 10.6)
5.1
(4.6, 5.8)
4.8
(3.1, 7.5)
39.1
(20.3, 61.9)
7.3
(5.1, 10.3)
19.7
(13.8, 27.4)
32.5
(24.4, 41.7)
12.0
(9.6, 14.9)
36.2
(26.9, 46.7)
38.5
(29.4, 48.5)
20.2
(16.5, 24.5)
38.8
(31.7, 46.3)
43.0
(32.1, 54.6)
24.6
(20.2, 29.5)
0.0
(0.0, 0.2)
0.1
(0.0, 0.2)
0.1
(0.0, 0.4)
2.2
(1.7, 3.0)
3.0
(2.3, 4.1)
1.9
(1.6, 2.2)
2.7
(2.1, 3.3)
7.1
(6.1, 8.3)
2.3
(2.0, 2.7)
0.0
0.0
0.0
-
0.0
0.0
0.0
-
1.1
(0.2, 5.4)
0.5
(0.1, 3.5)
0.1
(0.0, 0.3)
0.9
(0.2, 3.5)
1.2
(0.2, 7.8)
0.0
-
11.9
(2.8, 39.1)
0.0
0.0
-
0.0
0.0
0.0
-
0.5
(0.1, 2.7)
0.0
(0.0, 0.1)
0.0
-
0.4
(0.1, 2.4)
0.0
(0.0, 0.1)
0.0
-
3.6
(1.6, 7.6)
2.5
(1.2, 5.2)
50.8
(45.6, 56.0)
0.4
(0.2, 0.8)
2.1
(1.0, 4.7)
9.4
(6.8, 12.9)
16.3
(10.5, 24.5)
21.4
(15.2, 29.1)
32.2
(29.0, 35.5)
56.5
(36.1, 74.9)
44.5
(30.6, 59.4)
24.3
(20.0, 29.2)
8.0
(5.6, 11.3)
12.8
(7.5, 21.2)
8.7
(6.6, 11.3)
0.0
0.0
0.0
(0.0, 0.1)
1.0
(0.7, 1.4)
1.6
(1.2, 2.2)
1.9
(1.6, 2.2)
0.9
(0.6, 1.3)
1.7
(1.2, 2.3)
2.5
(2.2, 2.8)
2010
2011
2014
Oral Quinine
2010
2011
2014
2010
2011
2014
2010
2011
2014
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Page 85
Public
Health
Facility
%
(95% CI)
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
66.3
(55.1, 75.9)
77.3
(69.2, 83.8)
74.2
(69.5, 78.4)
5.9
(3.8, 9.2)
42.2
(21.3, 66.2)
13.1
(9.9, 17.3)
38.6
(25.0, 54.2)
47.7
(39.2, 56.4)
43.7
(40.3, 47.1)
ALL
Public
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
61.0
(38.5, 79.6)
48.6
(35.0, 62.3)
26.8
(22.3, 31.9)
22.5
(18.4, 27.3)
25.2
(17.5, 34.8)
15.6
(12.1, 19.9)
0.0
0.0
0.0
(0.0, 0.1)
2.1
(1.6, 2.6)
2.8
(2.2, 3.6)
2.7
(2.4, 3.1)
2.7
(2.2, 3.3)
7.3
(6.1, 8.6)
3.5
(3.1, 3.8)
Any treatment for severe malaria
2010
2011
2014
* The denominator includes outlets that met screening criteria for a full interview but did not complete the interview (were not interviewed or completed a partial interview).
Source: ACTwatch Outlet Survey, Kenya, 2010, 2011, 2014.
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Page 86
Table D2: Availability of antimalarials, among outlets stocking at least one antimalarial, by outlet type, across survey round
Public
Health
Facility
ALL
Public/Not-ForProfit**
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
2010 N=395
2011 N=428
2014 N=457
2010 N=455
2011 N=470
2014 N=517
2010 N=242
2011 N=272
2014 N=342
2010 N=216
2011 N=258
2014 N=487
2010 N=421
2011 N=475
2014 N=535
2010 N=553
2011 N=379
2014 N=252
2010 N=1,433
2011 N=1,384
2014 N=1,616
2010 N=1,888
2011 N=1,854
2014 N=2,133
88.8
(79.0, 94.3)
97.1
(93.8, 98.7)
83.5
(79.6, 86.8)
85.1
(74.6, 91.8)
97.3
(94.4, 98.7)
86.8
(83.2, 89.8)
56.9
(48.6, 64.9)
83.6
(77.3, 88.4)
92.6
(90.4, 94.3)
98.8
(95.1, 99.7)
95.3
(89.5, 97.9)
99.9
(99.7, 99.9)
46.6
(39.9, 53.5)
89.8
(82.9, 94.1)
92.1
(89.0, 94.3)
0.0
24.2
(14.3, 37.8)
27.0
(15.7, 42.5)
29.3
(24.3, 34.7)
62.8
(53.5, 71.2)
77.1
(69.8, 83.1)
38.6
(33.0, 44.5)
75.1
(68.3, 80.8)
78.3
(71.8, 83.7)
88.8
(79.0, 94.3)
97.0
(93.8, 98.6)
83.5
(79.6, 86.8)
83.5
(72.7, 90.6)
97.2
(94.3, 98.7)
86.8
(83.2, 89.8)
51.1
(43.7, 58.5)
82.5
(76.3, 87.4)
90.5
(88.4, 92.3)
96.6
(90.6, 98.8)
94.4
(88.9, 97.3)
97.8
(96.8, 98.5)
45.1
(39.2, 51.2)
88.3
(81.5, 92.8)
90.0
(87.1, 92.3)
0.0
24.2
(14.3, 37.8)
27.0
(15.7, 42.5)
27.8
(22.5, 33.7)
62.0
(52.9, 70.4)
75.6
(68.5, 81.4)
37.1
(31.3, 43.3)
74.6
(67.9, 80.3)
76.9
(70.6, 82.2)
87.6
(76.2, 94.0)
96.9
(93.7, 98.5)
83.4
(79.5, 86.6)
82.0
(70.8, 89.5)
97.1
(94.2, 98.6)
86.8
(83.1, 89.7)
37.3
(30.8, 44.3)
78.1
(72.1, 83.2)
83.6
(80.7, 86.1)
88.3
(82.7, 92.2)
91.2
(86.3, 94.5)
90.5
(88.8, 92.0)
33.0
(27.5, 39.0)
86.4
(79.2, 91.3)
84.2
(81.8, 86.3)
0.0
23.3
(13.6, 36.9)
26.2
(15.1, 41.6)
21.0
(16.3, 26.7)
59.9
(51.0, 68.2)
70.5
(64.4, 76.0)
31.2
(25.5, 37.6)
73.2
(66.7, 78.8)
72.5
(66.9, 77.5)
1.3
(0.6, 2.9)
68.6
(56.8, 78.4)
29.8
(24.0, 36.3)
1.3
(0.6, 2.7)
68.4
(56.9, 78.0)
40.2
(33.5, 47.3)
13.4
(9.5, 18.5)
72.7
(66.8, 77.9)
73.5
(69.1, 77.4)
49.6
(33.5, 65.7)
91.0
(85.9, 94.3)
85.9
(83.9, 87.7)
10.4
(4.8, 21.1)
83.8
(76.1, 89.4)
76.1
(72.6, 79.4)
0.0
22.8
(13.4, 36.1)
21.4
(12.9, 33.4)
7.7
(4.9, 11.9)
58.0
(49.2, 66.3)
63.0
(57.6, 68.2)
6.7
(4.4, 10.0)
61.7
(54.1, 68.8)
60.3
(55.5, 64.9)
Any ACT
2010
2011
2014
2010
2011
2014
2010
2011
2014
2010
2011
2014
www.ACTwatch.info
Page 87
Public
Health
Facility
ALL
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
87.2
(76.0, 93.6)
64.1
(50.8, 75.5)
69.8
(64.0, 75.0)
81.3
(70.2, 88.9)
63.5
(50.8, 74.6)
64.2
(56.7, 71.2)
28.2
(21.3, 36.4)
13.2
(8.5, 20.0)
20.4
(17.2, 23.9)
80.3
(73.5, 85.7)
17.8
(15.1, 20.8)
25.7
(20.8, 31.2)
7.3
(4.3, 12.2)
17.5
(15.1, 20.2)
0.0
5.5
(2.2, 13.3)
16.7
(12.0, 22.7)
6.0
(4.5, 8.0)
15.4
(13.3, 17.8)
27.5
(21.8, 34.0)
26.5
(21.6, 32.1)
21.3
(18.5, 24.5)
3.7
(2.0, 6.6)
6.3
(3.4, 11.6)
2.7
(1.9, 3.8)
8.8
(4.9, 15.5)
6.6
(3.8, 11.3)
14.0
(7.9, 23.5)
42.6
(34.8, 50.7)
33.0
(24.4, 42.9)
49.4
(44.8, 54.0)
98.1
(93.6, 99.5)
88.3
(81.9, 92.6)
87.7
(84.2, 90.5)
29.3
(20.5, 39.9)
39.6
(30.8, 49.1)
50.1
(43.2, 57.0)
0.0
1.2
(0.4, 3.9)
2.0
(0.7, 5.2)
20.8
(17.1, 25.1)
28.3
(22.2, 35.4)
41.6
(36.0, 47.5)
18.8
(15.8, 22.3)
20.6
(16.3, 25.6)
38.3
(33.1, 43.7)
95.2
(92.0, 97.2)
94.3
(88.5, 97.2)
75.5
(70.1, 80.2)
81.7
(55.2, 94.2)
94.2
(89.0, 97.1)
66.8
(59.4, 73.4)
83.2
(73.2, 90.0)
75.1
(69.5, 80.0)
52.3
(47.5, 57.0)
79.0
(71.9, 84.8)
84.8
(77.3, 90.1)
64.3
(60.6, 67.9)
90.8
(87.5, 93.3)
79.9
(72.3, 85.8)
70.3
(66.9, 73.6)
100.0
84.0
(75.7, 89.9)
80.9
(68.6, 89.1)
93.4
(91.0, 95.2)
81.3
(77.4, 84.6)
67.6
(63.4, 71.6)
91.4
(86.4, 94.7)
85.9
(82.5, 88.7)
67.5
(63.7, 71.1)
74.6
(65.2, 82.1)
57.2
(45.2, 68.5)
15.0
(10.5, 21.1)
65.4
(47.7, 79.6)
58.0
(46.4, 68.7)
16.5
(12.6, 21.3)
42.9
(31.9, 54.6)
41.7
(32.2, 51.8)
24.7
(21.7, 28.0)
33.6
(24.8, 43.7)
65.1
(54.0, 74.7)
52.8
(49.4, 56.2)
78.2
(70.9, 84.2)
57.1
(49.4, 64.5)
57.5
(54.0, 60.8)
68.5
(56.2, 78.7)
53.5
(45.4, 61.4)
62.0
(48.0, 74.3)
67.0
(59.0, 74.1)
53.8
(49.0, 58.5)
49.6
(45.5, 53.6)
66.7
(59.0, 73.7)
55.3
(50.2, 60.3)
45.6
(41.9, 49.3)
2010
2011
2014
Non-Quality Assured ACT (non-QA ACT)
2010
2011
2014
2010
2011
2014
2010
2011
2014
www.ACTwatch.info
Page 88
Public
Health
Facility
ALL
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
64.7
(56.5, 72.2)
75.1
(68.1, 80.9)
44.9
(39.0, 50.9)
48.0
(34.9, 61.4)
74.5
(67.9, 80.1)
39.2
(31.9, 47.0)
31.6
(23.7, 40.6)
36.5
(28.5, 45.5)
16.3
(13.3, 19.8)
39.3
(27.8, 52.0)
39.2
(30.2, 49.0)
21.0
(17.3, 25.2)
44.0
(35.6, 52.8)
45.5
(34.4, 57.1)
26.4
(21.7, 31.7)
0.7
(0.1, 5.2)
1.1
(0.3, 3.3)
4.0
(1.1, 13.1)
22.6
(17.0, 29.2)
25.2
(19.5, 32.0)
17.8
(15.5, 20.4)
26.8
(22.0, 32.3)
42.8
(38.0, 47.8)
20.4
(17.8, 23.3)
0.0
0.0
0.0
-
0.0
0.0
0.0
-
1.8
(0.4, 8.4)
0.6
(0.1, 4.0)
0.2
(0.1, 0.4)
1.0
(0.3, 3.7)
1.2
(0.2, 7.9)
0.0
-
13.5
(3.1, 42.9)
0.0
0.0
-
0.0
0.0
0.0
-
5.2
(1.0, 23.9)
0.2
(0.1, 1.0)
0.0
(0.0, 0.1)
4.4
(0.8, 20.7)
0.2
(0.0, 0.6)
0.0
(0.0, 0.1)
3.9
(1.7, 8.7)
2.6
(1.3, 5.3)
54.9
(49.0, 60.7)
4.2
(2.3, 7.5)
4.1
(2.3, 7.0)
50.7
(43.9, 57.6)
26.1
(19.1, 34.7)
24.0
(17.0, 32.8)
43.9
(39.8, 48.1)
61.3
(36.2, 81.6)
45.3
(31.1, 60.3)
25.3
(21.1, 30.0)
9.1
(6.4, 12.7)
13.6
(7.9, 22.5)
9.3
(7.1, 12.2)
0.0
0.0
0.8
(0.3, 2.4)
9.6
(6.5, 13.9)
13.5
(9.8, 18.4)
17.8
(15.3, 20.6)
8.7
(5.9, 12.6)
10.1
(7.6, 13.4)
21.8
(19.3, 24.5)
72.3
(61.5, 81.0)
79.9
(70.7, 86.7)
80.2
(75.6, 84.1)
59.1
(43.1, 73.4)
80.2
(72.0, 86.5)
70.6
(63.2, 77.0)
61.7
(47.4, 74.3)
53.7
(45.3, 62.0)
59.6
(55.3, 63.7)
66.2
(37.9, 86.2)
49.4
(35.6, 63.3)
27.9
(23.5, 32.7)
25.6
(21.1, 30.6)
26.7
(18.6, 36.6)
16.8
(13.0, 21.4)
0.0
0.0
1.2
(0.4, 3.1)
20.9
(15.8, 27.1)
23.3
(18.7, 28.6)
25.2
(22.1, 28.6)
27.3
(22.0, 33.4)
43.6
(37.9, 49.5)
30.7
(27.5, 34.2)
Oral Quinine
2010
2011
2014
2010
2011
2014
2010
2011
2014
Any treatment for severe malaria
2010
2011
2014
* Antimalarial‐stocking outlets have at least one antimalarial in stock on the day of the survey, verified by presence of at least one antimalarial recorded in the antimalarial audit sheet.
www.ACTwatch.info
Page 89
Table D3: Antimalarial market composition, across survey round
survey:*
2010, N=1,471 outlets
2011, N=1,348 outlets
2014, N=1,501 outlets
Public
Health
Facility
ALL
Public
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
%
%
%
%
%
%
%
11.2
17.2
12.0
2.5
30.6
37.5
82.8
(8.3, 15.1)
(11.7, 24.6)
(8.3, 17.1)
(1.4, 4.7)
(18.9, 45.5)
(27.8, 48.3)
(75.4, 88.3)
13.0
16.4
18.8
3.3
30.1
31.5
83.6
(10.2, 16.3)
(13.3, 20.0)
(14.5, 24.0)
(1.9, 5.7)
(24.9, 35.9)
(24.3, 39.6)
(80.0, 86.7)
9.5
14.0
21.4
11.8
33.0
19.8
86.0
(7.9, 11.4)
(11.7, 16.8)
(19.3, 23.6)
(8.6, 16.0)
(28.3, 38.0)
(14.5, 26.4)
(83.2, 88.3)
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Page 90
Table D4: Price of tablet formulation antimalarials in 2010 USD, by outlet type, across survey round
Private
For-Profit
Facility
Registered Pharmacy
General Retailer
ALL
Private
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
$3.45
[0.92-5.18] (308)
$0.58
[0.46-2.30] (479)
$2.63
[1.58-5.25] (655)
$4.90
[3.24-7.25] (1,173)
$3.45
[0.61-5.18] (1,363)
$3.94
[1.84-6.56] (2,115)
$4.03
[2.30-5.83] (702)
$0.81
[0.46-3.68] (1,356)
$2.63
[1.40-5.25] (1,432)
$0.46
[0.46-0.46] (114)
$1.97
[1.31-3.94] (84)
$4.03
[2.30-6.10] (2,183)
$0.92
[0.46-4.03] (3,312)
$2.63
[1.58-5.25] (4,286)
$1.15
[0.00-3.45] (138)
$0.58
[0.46-1.15] (342)
$1.97
[1.31-2.63] (433)
$4.61
[1.15-5.99] (331)
$0.61
[0.46-1.38] (671)
$1.58
[1.31-2.10] (889)
$2.30
[1.38-5.53] (273)
$0.58
[0.46-0.92] (882)
$1.58
[1.31-2.10] (818)
$0.46
[0.46-0.46] (111)
$1.40
[1.31-1.97] (69)
$2.30
[1.15-5.53] (742)
$0.52
[0.46-0.92] (2,006)
$1.75
[1.31-2.63] (2,209)
$1.15
[0.92-1.38] (39)
$0.58
[0.46-1.15] (303)
$1.97
[1.31-2.63] (360)
$0.92
[0.69-1.15] (98)
$0.61
[0.46-1.20] (641)
$1.58
[1.31-2.10] (784)
$1.15
[0.92-2.30] (108)
$0.52
[0.46-0.92] (840)
$1.58
[1.31-2.10] (725)
$0.46
[0.46-0.46] (108)
$1.31
[1.31-1.97] (61)
$1.15
[0.81-1.73] (245)
$0.46
[0.46-0.92] (1,892)
$1.75
[1.31-2.63] (1,930)
$1.15
[0.00-4.61] (99)
$0.00
[0.00-0.92] (39)
$1.97
[1.31-2.63] (71)
$5.76
[4.03-6.91] (232)
$2.30
[1.15-11.05] (30)
$1.40
[1.31-2.10] (105)
$3.45
[2.30-5.76] (165)
$0.69
[0.46-2.30] (42)
$1.58
[1.31-1.97] (92)
$0.46
[0.46-0.69] (3)
$1.97
[1.31-1.97] (8)
$3.45
[1.84-5.76] (496)
$0.58
[0.00-1.84] (114)
$1.58
[1.31-1.97] (276)
Any ACT
2010
2011
2014
Quality-assured ACT (QA ACT)
2010
2011
2014
2010
2011
2014
2010
2011
2014
www.ACTwatch.info
Page 91
Private
For-Profit
Facility
Registered Pharmacy
General Retailer
ALL
Private
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
$4.53
[3.22-6.45] (170)
$4.61
[3.45-6.91] (137)
$5.25
[3.94-6.56] (222)
$5.07
[3.68-9.21] (842)
$5.18
[4.03-8.63] (692)
$5.61
[3.94-10.59] (1,226)
$4.61
[3.45-6.33] (429)
$4.61
[4.03-5.76] (474)
$5.25
[4.07-9.19] (614)
$0.46
[0.46-0.46] (3)
$6.56
[3.94-13.13] (15)
$4.61
[3.45-6.91] (1,441)
$4.61
[3.80-7.25] (1,306)
$5.25
[3.94-8.40] (2,077)
$0.81
[0.40-1.21] (109)
$0.58
[0.35-0.92] (116)
$0.66
[0.53-1.31] (97)
$0.69
[0.35-1.04] (175)
$0.92
[0.52-1.73] (268)
$0.79
[0.66-1.97] (480)
$0.69
[0.46-1.04] (533)
$0.58
[0.40-1.15] (395)
$0.66
[0.66-1.31] (481)
$0.35
[0.35-0.46] (417)
$0.35
[0.35-0.46] (198)
$0.39
[0.39-0.53] (195)
$0.46
[0.35-0.86] (1,235)
$0.46
[0.35-1.04] (977)
$0.66
[0.46-1.05] (1,253)
$1.15
[0.69-3.45] (98)
$0.46
[0.46-0.69] (227)
$1.84
[1.31-1.97] (255)
$4.84
[1.15-5.99] (286)
$0.46
[0.46-0.52] (321)
$1.31
[1.31-1.97] (504)
$2.53
[1.15-5.76] (238)
$0.46
[0.46-0.58] (533)
$1.31
[1.31-1.97] (488)
$0.46
[0.46-0.46] (95)
$1.31
[1.31-1.97] (42)
$2.53
[1.15-5.76] (622)
$0.46
[0.46-0.58] (1,176)
$1.31
[1.31-1.97] (1,289)
Non-quality assured ACT
2010
2011
2014
2010
2011
2014
Pre-packaged adult QA AL
2010
2011
2014
www.ACTwatch.info
Page 92
Private
For-Profit
Facility
Registered Pharmacy
General Retailer
ALL
Private
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
$0.00
[0.00-0.66] (11)
$0.53
[0.00-0.66] (34)
$0.79
[0.66-1.31] (67)
$1.97
[1.58-2.63] (13)
$0.53
[0.39-0.53] (131)
$0.66
[0.53-1.05] (171)
$0.66
[0.53-0.66] (9)
$0.53
[0.39-0.53] (116)
$0.66
[0.66-1.05] (134)
$0.53
[0.20-0.53] (7)
$0.66
[0.66-1.31] (6)
$0.66
[0.53-1.97] (33)
$0.53
[0.39-0.53] (288)
$0.66
[0.66-1.31] (378)
Pre-packaged Pediatric QA AL
2010
2011
2014
Figures in this table are derived using audited products with price information.
www.ACTwatch.info
Page 93
Table D5: Availability of malaria blood testing among antimalarial-stocking outlets*, by outlet type, across survey round
Proportion of outlets***
stocking
Public
Health
Facility
%
(95% CI)
%
(95% CI)
Private
For-Profit
Facility
%
(95% CI)
2010 N=404
2011 N=432
2014 N=471
2010 N=506
2011 N=477
2014 N=573
45.5
(39.0, 52.1)
55.4
(48.2, 62.4)
94.1
(90.1, 96.5)
ALL
Public
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
2010 N=270
2011 N=281
2014 N=375
2010 N=213
2011 N=256
2014 N=490
2010 N=444
2011 N=491
2014 N=556
2010 N=1,100
2011 N=575
2014 N=405
2010 N=2,030
2011 N=1,603
2014 N=1,826
2010 N=2,536
2011 N=2,080
2014 N=2,399
31.8
(20.9, 45.2)
57.2
(50.5, 63.7)
73.3
(53.0, 86.9)
52.8
(41.2, 64.1)
44.5
(34.7, 54.7)
74.3
(70.1, 78.0)
12.7
(7.5, 20.7)
18.0
(11.5, 27.1)
21.0
(18.0, 24.4)
10.5
(7.7, 14.1)
7.1
(4.8, 10.6)
16.2
(13.1, 19.7)
0.0
0.0
0.0
-
9.0
(7.4, 10.9)
10.4
(8.1, 13.3)
25.3
(21.4, 29.6)
12.7
(10.7, 15.0)
25.5
(22.1, 29.3)
31.7
(28.1, 35.5)
2010 N=404
2011 N=432
2014 N=470
2010 N=506
2011 N=477
2014 N=571
2010 N=270
2011 N=280
2014 N=375
2010 N=213
2011 N=256
2014 N=490
2010 N=443
2011 N=488
2014 N=555
2010 N=1,098
2011 N=571
2014 N=403
2010 N=2,027
2011 N=1,595
2014 N=1,823
2010 N=2,533
2011 N=2,072
2014 N=2,394
40.5
(33.6, 47.8)
41.6
(33.2, 50.5)
60.9
(56.8, 64.9)
29.5
(19.6, 41.7)
44.5
(36.0, 53.3)
47.3
(33.5, 61.6)
48.5
(37.7, 59.4)
40.2
(30.4, 50.8)
61.1
(56.7, 65.4)
7.7
(2.9, 19.2)
12.2
(6.3, 22.5)
8.2
(6.5, 10.4)
8.9
(5.8, 13.3)
6.0
(3.8, 9.2)
5.7
(4.1, 7.7)
0.0
0.0
0.0
-
7.9
(6.4, 9.8)
8.9
(6.9, 11.4)
17.4
(14.8, 20.5)
11.4
(9.7, 13.5)
20.4
(17.5, 23.6)
21.5
(18.7, 24.4)
2010 N=403
2011 N=432
2014 N=470
2010 N=505
2011 N=477
2014 N=571
2010 N=269
2011 N=281
2014 N=375
2010 N=213
2011 N=256
2014 N=490
2010 N=443
2011 N=491
2014 N=555
2010 N=1,091
2011 N=575
2014 N=403
2010 N=2,019
2011 N=1,603
2014 N=1,823
2010 N=2,524
2011 N=2,080
2014 N=2,394
6.0
(2.9, 12.1)
19.4
(9.9, 34.4)
68.2
(62.7, 73.3)
5.1
(2.3, 10.9)
18.4
(9.6, 32.3)
51.7
(39.7, 63.5)
6.7
(3.2, 13.6)
6.7
(3.7, 11.8)
29.2
(25.7, 33.0)
5.6
(3.6, 8.5)
6.7
(3.2, 13.6)
15.0
(11.8, 18.9)
1.9
(0.5, 6.5)
1.8
(0.8, 3.7)
12.3
(10.2, 14.8)
0.0
0.0
0.0
-
1.4
(0.8, 2.5)
2.1
(1.3, 3.4)
12.6
(10.5, 15.0)
2.0
(1.3, 3.0)
7.4
(4.2, 12.7)
17.8
(15.7, 20.1)
2010
2011
2014
2010
2011
2014
2010
2011
2014
** Results in this table are derived using responses captured among outlets with blood testing information.
www.ACTwatch.info
Page 94
Table D7: Price of malaria blood testing in 2010 USD, by outlet type, across survey round
Private
For-Profit
Facility
consumers:*
Registered Pharmacy
ALL
Private
Median [IQR]
Median [IQR]
Median [IQR]
Median [IQR]
$0.66
[0.66-1.31] (159)
$0.58
[0.58-1.15] (157)
$1.31
[0.66-1.31] (263)
$0.66
[0.53-1.31] (27)
$1.15
[0.58-1.15] (26)
$1.31
[1.31-1.31] (55)
$0.66
[0.66-1.31] (34)
$0.58
[0.58-0.92] (31)
$1.31
[1.31-1.31] (30)
$0.66
[0.66-1.31] (220)
$0.58
[0.58-1.15] (214)
$1.31
[0.66-1.31] (348)
$0.66
[0.66-1.31] (160)
$0.58
[0.46-0.81] (156)
$1.31
[0.66-1.31] (263)
$0.66
[0.53-1.31] (26)
$0.58
[0.58-1.15] (25)
$1.31
[1.31-1.31] (55)
$0.66
[0.66-1.31] (34)
$0.58
[0.58-0.92] (31)
$1.31
[1.31-1.31] (30)
$0.66
[0.66-1.31] (220)
$0.58
[0.58-1.15] (212)
$1.31
[0.66-1.31] (348)
$0.00
[0.00-1.31] (21)
$0.58
[0.35-1.15] (23)
$1.31
[1.31-1.97] (134)
$0.92
[0.92-2.63] (16)
$1.73
[1.15-1.73] (29)
$1.31
[1.31-1.31] (55)
$1.31
[1.31-1.31] (8)
$1.15
[0.58-1.73] (15)
$1.31
[1.31-1.97] (59)
$1.31
[0.00-1.31] (45)
$1.15
[0.58-1.73] (67)
$1.31
[1.31-1.97] (248)
$0.00
[0.00-1.31] (21)
$0.58
[0.23-1.15] (23)
$1.31
[1.31-1.97] (133)
$0.92
[0.92-2.63] (16)
$1.15
[1.15-1.73] (28)
$1.31
[1.31-1.31] (53)
$1.31
[1.31-1.31] (8)
$1.15
[0.58-1.38] (15)
$1.31
[1.31-1.31] (59)
$1.31
[0.00-1.31] (45)
$1.15
[0.58-1.38] (66)
$1.31
[1.31-1.97] (245)
Adult
2010
2011
2014
Child under age five
2010
2011
2014
Adult
2010
2011
2014
Child under five
2010
2011
2014
*
Total price to the consumer including consultation and/or service fees.
www.ACTwatch.info
Page 95
Table D8: Antimalarial market share, across survey round
distributed:
Public
Health
Facility
TOTAL
Public/Not ForProfit
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
TOTAL
Private
ANTI-MALARIAL
TOTAL*
%
%
%
%
%
%
%
%
4.7
2.5
1.9
2.3
4.4
4.1
0.0
0.1
9.2
6.3
3.4
1.4
2.9
33.2
30.2
0.8
0.2
40.6
0.0
0.0
0.0
0.0
6.1
5.3
0.0
0.0
6.1
15.3
8.1
4.3
7.1
50.2
45.2
0.9
0.5
67.0
33.4
25.8
4.4
7.6
65.0
58.9
0.9
0.6
100.0
3.2
2.6
2.6
0.6
2.5
2.4
0.0
0.0
5.7
28.1
25.8
25.0
2.3
9.2
7.9
0.0
0.1
37.4
2.5
2.3
2.3
0.2
2.2
1.9
0.0
0.0
4.7
43.8
39.4
37.4
4.4
19.2
16.9
0.0
0.2
63.3
61.7
57.3
50.6
4.5
38.0
34.3
0.0
0.2
100.0
27.4
17.4
14.1
10.0
12.6
11.8
0.0
0.6
40.6
20.8
16.3
14.1
4.5
9.5
9.0
0.0
0.2
30.5
2.3
1.8
1.4
0.5
2.6
2.5
0.0
0.0
4.9
60.0
42.3
35.1
17.7
26.5
24.9
0.0
1.2
87.7
70.0
51.7
39.9
18.3
28.6
26.4
0.0
1.4
100.0
2010
1. Any ACT
15.9
18.1
4.3
15.8
17.7
2.3
0.1
0.1
0.9
0.1
0.4
2.0
10.4
14.8
6.4
9.5
13.7
5.7
0.0
0.0
0.1
0.0
0.1
0.2
OUTLET TYPE TOTAL***
26.4
33.0
11.0
2011
1. Any ACT
15.6
17.9
10.1
15.6
17.9
8.7
12.0
13.1
7.6
0.0
0.0
1.4
18.2
18.8
5.3
17.1
17.5
4.7
0.0
0.0
0.0
0.0
0.0
0.1
33.9
36.7
15.5
2014
1. Any ACT
7.5
10.0
9.6
7.4
9.4
6.9
3.8
4.8
5.5
0.1
0.6
2.7
1.8
2.1
1.8
1.4
1.5
1.6
0.0
0.0
0.0
0.1
0.2
0.3
9.4
12.3
11.7
* Row sum – market share for the specified antimalarial medicine.
*** Column sum (within each survey round) – market share for the specified outlet type.
Categories 1 through 4 sum to 100% in the far-right column – antimalarial total column (within in survey round).
www.ACTwatch.info
Page 96
Table D9: Antimalarial market share, across outlet type, across survey round
Public
Health
Facility
TOTAL
Public / Not-ForProfit
Private
For-Profit
Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
TOTAL
Private
%
%
%
%
%
%
%
2010
1. Any ACT
60.4
60.0
0.3
0.4
39.5
35.9
0.0
0.1
54.9
53.6
0.3
1.3
44.9
41.3
0.0
0.2
39.0
20.6
8.5
18.4
58.4
51.4
1.1
1.4
51.3
26.7
20.5
24.6
47.2
44.0
0.0
1.5
15.4
8.4
3.5
7.0
82.0
74.4
2.0
0.6
0.0
0.0
0.0
0.0
100.0
87.0
0.0
0.0
22.8
12.1
6.4
10.7
75.0
67.6
1.4
0.8
2011
1. Any ACT
46.1
46.1
35.4
0.1
53.9
50.4
0.0
0.0
48.8
48.7
35.8
0.1
51.1
47.6
0.0
0.0
64.9
56.1
49.0
8.8
34.0
30.2
0.3
0.8
55.9
45.1
45.0
10.8
43.6
42.3
0.0
0.5
75.1
69.0
66.8
6.1
24.7
21.1
0.0
0.2
52.8
49.1
48.5
3.7
47.2
40.2
0.0
0.0
69.2
62.2
59.1
7.0
30.4
26.6
0.1
0.4
81.7
58.9
47.3
22.7
15.3
13.4
0.1
2.9
67.4
42.8
34.8
24.6
31.1
29.2
0.0
1.5
68.1
53.3
46.1
14.9
31.1
29.4
0.0
0.7
46.7
36.0
28.5
10.7
53.3
51.8
0.0
0.0
68.4
48.2
40.0
20.2
30.2
28.4
0.0
1.3
distributed:
2014
1. Any ACT
79.5
81.2
78.9
76.6
41.0
39.2
0.6
4.7
19.4
17.0
15.4
12.1
0.0
0.0
1.1
1.7
Categories 1 through 4 sum to 100% within each column (within each survey round).
www.ACTwatch.info
Page 97
Table D12: Provider antimalarial treatment knowledge and practices, by outlet type, across survey round
Public
Health
Facility
%
(95% CI)
ALL
Public / Not forprofit
%
(95% CI)
Private
for-profit
HF
%
(95% CI)
2010 N=407
2011 N=432
2014 N=471
2010 N=509
2011 N=477
2014 N=573
96.7
(94.2, 98.2)
97.6
(95.0, 98.9)
98.7
(97.5, 99.3)
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
2010 N=270
2011 N=282
2014 N=375
2010 N=216
2011 N=259
2014 N=492
2010 N=444
2011 N=492
2014 N=557
2010 N=1,112
2011 N=576
2014 N=408
2010 N=2,045
2011 N=1,609
2014 N=1,832
2010 N=2,554
2011 N=2,086
2014 N=2,405
83.0
(71.2, 90.6)
97.0
(94.6, 98.4)
96.1
(93.9, 97.5)
77.3
(68.0, 84.5)
86.4
(77.3, 92.2)
92.8
(90.9, 94.3)
97.3
(92.1, 99.1)
90.9
(85.1, 94.6)
96.2
(93.9, 97.6)
61.9
(48.8, 73.4)
84.5
(78.4, 89.1)
91.0
(88.9, 92.7)
15.5
(11.1, 21.1)
29.9
(20.5, 41.2)
29.3
(22.9, 36.6)
36.8
(32.6, 41.2)
58.6
(50.6, 66.2)
71.5
(64.4, 77.7)
44.3
(39.5, 49.1)
71.0
(65.1, 76.3)
74.8
(68.4, 80.3)
68.1
(57.1, 77.4)
85.5
(78.9, 90.3)
95.9
(92.9, 97.7)
43.7
(30.1, 58.3)
85.8
(79.8, 90.3)
88.4
(84.1, 91.6)
31.0
(24.9, 37.9)
69.8
(61.9, 76.7)
87.8
(85.7, 89.7)
85.1
(77.4, 90.5)
80.0
(73.1, 85.4)
89.9
(87.9, 91.6)
27.0
(22.5, 32.1)
76.9
(70.1, 82.5)
86.2
(83.8, 88.3)
11.8
(7.6, 18.0)
17.3
(12.9, 22.6)
12.9
(9.8, 16.9)
44.1
(38.0, 50.5)
64.2
(57.0, 70.8)
17.9
(14.7, 21.7)
57.5
(51.8, 63.1)
67.4
(61.0, 73.3)
64.4
(54.0, 73.6)
83.7
(76.1, 89.2)
42.8
(32.3, 54.0)
83.3
(76.7, 88.3)
20.4
(14.1, 28.6)
49.4
(41.7, 57.1)
68.8
(54.7, 80.1)
63.7
(54.3, 72.2)
14.5
(10.9, 19.0)
52.6
(45.8, 59.4)
5.4
(3.0, 9.6)
8.0
(10.7, 17.1)
30.0
(24.7, 35.9)
13.6
(15.0, 24.9)
47.1
(41.6, 52.8)
87.8
(84.4, 90.6)
79.1
(72.4, 84.4)
73.0
(69.4, 76.3)
81.1
(78.6, 83.3)
73.9
(70.6, 76.9)
10.1
(7.0, 14.3)
53.2
(47.0, 59.3)
56.7
(51.0, 62.2)
www.ACTwatch.info
Page 98
Correctly state the national
first-line treatment for
uncomplicated malaria
2010
2011
2014
Correctly state the first-line
dosing regimen for*:
An adult
2010
2011
2014
2010
2011
2014
Table D12: Provider antimalarial treatment knowledge and practices, by outlet type, across survey round
Public
Health
Facility
%
(95% CI)
ALL
Public / Not forprofit
%
(95% CI)
Private
for-profit
HF
%
(95% CI)
2010 N=407
2011 N=432
2014 N=471
2010 N=509
2011 N=477
2014 N=573
84.6
(79.6, 88.5)
95.7
(92.5, 97.5)
96.7
(94.6, 98.0)
87.7
(83.0, 91.3)
95.3
(91.0, 97.6)
94.7
(92.6, 96.3)
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Private
ALL
Outlets
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
%
(95% CI)
2010 N=270
2011 N=282
2014 N=375
2010 N=216
2011 N=259
2014 N=492
2010 N=444
2011 N=492
2014 N=557
2010 N=1,112
2011 N=576
2014 N=408
2010 N=2,045
2011 N=1,609
2014 N=1,832
2010 N=2,554
2011 N=2,086
2014 N=2,405
66.5
(57.7, 74.4)
94.8
(91.6, 96.8)
93.9
(90.6, 96.2)
50.6
(42.2, 58.8)
82.7
(76.1, 87.8)
89.2
(86.7, 91.3)
89.4
(83.7, 93.3)
89.8
(81.4, 94.7)
95.0
(93.3, 96.2)
38.3
(26.0, 52.3)
88.1
(81.5, 92.6)
87.6
(85.7, 89.3)
4.7
(2.9, 7.5)
25.7
(16.8, 37.2)
29.1
(19.7, 40.7)
21.0
(17.6, 24.8)
56.8
(48.3, 64.9)
69.3
(61.2, 76.4)
28.3
(24.0, 33.1)
69.0
(62.5, 74.9)
72.6
(65.3, 78.9)
68.9
(55.5, 79.7)
94.7
(90.5, 97.1)
91.6
(88.6, 93.8)
42.1
(34.1, 50.4)
79.2
(72.1, 84.9)
87.3
(84.5, 89.6)
88.2
(82.3, 92.3)
96.3
(92.3, 98.3)
96.3
(94.8, 97.4)
35.3
(26.4, 45.3)
75.8
(67.1, 82.8)
85.6
(83.0, 87.8)
3.9
(2.4, 6.5)
18.6
(12.1, 27.5)
21.9
(14.4, 31.8)
18.8
(15.5, 22.6)
50.2
(42.4, 57.9)
65.8
(57.7, 73.2)
26.8
(22.2, 32.0)
64.5
(58.4, 70.2)
69.3
(62.1, 75.7)
www.ACTwatch.info
Page 99
Report an ACT as the
most effective
antimalarial medicine
For adults
2010
2011
2014
For children
2010
2011
2014

Numbers of providers (N) in this table are the total number of providers eligible for table indicators.
* In 2010 and 2011, this question was only administered in QA ACT-stocking outlets.
Annex 1: ACTwatch Background
ACTwatch is a multi-country research project implemented by PSI (www.psi.org). Standardized tools and approaches
are employed to provide comparable data across countries and over time. Project countries include: Benin, Cambodia,
the Democratic Republic of Congo, Kenya, Laos, Madagascar, Myanmar, Nigeria, Tanzania (currently mainland only,
previous work in Zanzibar), Thailand, Uganda, Vietnam, and Zambia. The project was launched in 2008 with funding
from the Bill and Melinda Gates Foundation (BMGF), and is currently funded through 2016 by the BMGF, UNITAID,
and DFID.
ACTwatch is designed to provide timely, relevant, and high quality antimalarial market evidence.2 The goal of providing
this market evidence is to inform and monitor national and global policy, strategy, and funding decisions for improving
malaria case management. ACTwatch is monitoring antimalarial markets in the context of policy shifts and
investments in the scale-up of first-line ACT and blood testing using RDTs. This has included adaptation of project
methods for the evaluation of the Affordable Medicines Facility-malaria (AMFm) pilot.3 The project implements a set
of research tools designed to:
1) Provide a picture of the total market for malaria case management including: all providers carrying antimalarials
and RDTs and providing case management services; the relative antimalarial market share for each provider type;
the antimalarial supply chain; and price markups within the supply chain for antimalarials and RDTs.
2) Monitor the readiness of market components for appropriate malaria case management, including: availability
of antimalarials and malaria blood testing; consumer price of antimalarial treatment and malaria blood testing;
and provider qualifications, training and knowledge.
3) Monitor the performance of market components for appropriate malaria case management, including: the
relative market share for quality-assured ACT relative to other antimalarial medicines; the demand for appropriate
malaria case management captured through consumer knowledge, attitudes, and fever treatment seeking
behavior; and the quality of provider service delivery measured against national policies, guidelines and minimum
standards.
ACTwatch research tools for malaria market monitoring include:
1.
Outlet surveys
Outlet surveys entail collecting quantitative data from all outlets and providers with the potential to sell or distribute
antimalarials and/or provide malaria blood testing. These include health facilities, community health workers,
pharmacies, Unregistered Pharmacies, retail outlets, market stalls, and mobile providers. A screening process
identifies outlets that provide antimalarials and/or malaria blood testing. Among these eligible outlets, service
providers are interviewed and all antimalarials and RDTs are audited. The audit collects information about each
antimalarial and RDT in stock (e.g. brand name, drug active ingredients and strengths, manufacturer, etc.) and retailer
reports on consumer price and sale/distribution volumes for each product. A representative sample of outlets is
identified within target study domains such that findings from the outlet survey provide estimates of antimalarial and
RDT availability, price, and relative market share across the entire market as well as within key market segments.4
2
Shewchuk T, O’Connell KA, Goodman C, Hanson K, Chapman S, Chavasse D. 2011. The ACTwatch project: methods to describe anti-malarial
markets in seven countries. Malaria Journal, 10: 325.
3 AMFm Independent Evaluation Team. 2012. Independent evaluation of Phase 1 of the Affordable Medicines Facility – malaria (AMFm), multicountry independent evaluation report: final report. Calverton, MD and London: ICF International and London School of Hygiene and Tropical
Medicine.
4 O’Connell KA, Poyer S, Solomon T, et al. 2013. Methods for implementing a medicine outlet survey: lessons from the anti-malarial market.
Malaria Journal, 12: 52.
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From 2008 through 2014, ACTwatch conducted 35 national outlet surveys across the 10 project countries.5 Reports
are available at www.actwatch.info, and peer-reviewed publications have appeared in Malaria Journal and The
Lancet.6
2.
Supply chain studies
Supply chain studies employ quantitative and qualitative research methods to effectively map the antimalarial supply
chain in a given country. The supply chain is mapped from the antimalarial outlets (service delivery points) identified
during an outlet survey to national importers and distributors with identification of all mid-level distributers in
between. Retail prices are documented along the supply chain to facilitate calculation of commodity mark-ups. From
2008 through 2012, ACTwatch conducted 8 national supply chain studies. Reports are available at www.actwatch.info,
and a peer-reviewed publication has appeared in PLoS One.7
3.
Population-based surveys
Population-based surveys are conducted among consumers to document fever treatment-seeking behavior. A
representative sample of the target population (caregivers of children and/or adults according to burden and risk) is
identified, and a screening tool is used to identify individuals who have recently experienced fever. The surveys
investigate the extent to which health care was sought, as well as common sources of care received. Respondent
reports of malaria blood testing and antimalarials acquired are documented and summarized. The survey includes
measures of demographic and other individual, household/family, and community characteristics that can be used to
develop consumer profiles as well as monitor equity in access to malaria case management. From 2008 through 2012,
ACTwatch conducted 14 household surveys focused on fever treatment-seeking behavior. Reports are available at
www.actwatch.info, and a peer-reviewed publication has appeared in Malaria Journal.8
4.
Fever case management quality of care
Fever case management quality of care is monitored using a set of research tools designed to measure aspects of the
interaction between providers and clients. In 2015-2016, ACTwatch will launch fever case management quality of care
studies in a subset of project countries. The tool or set of tools that is most appropriate and feasible in a given context
is employed. These include:

Exit interviews conducted with target consumers immediately after receiving fever case management services
from target providers. A structured interview documents client reports about key aspects of service delivery
including malaria blood testing, test results, medicines recommended/prescribed and obtained, counseling, and
costs of services and commodities received. Exit interviews are also used to measure client recall and
comprehension of provider counseling including instructions for completing prescribed drug regimens, as well as
client satisfaction with services provided. Exit interviews may include measures of demographic characteristics to
monitor equity in access to services and commodities.

Structured observation documents aspects of the provider-client interaction using a checklist. A trained observer
completes the checklist designed to document provider compliance with standard practice and procedures as well
as aspects of client demand for specific products or services. The observer remains silent during the consultation.
5
Surveys in the DRC (2) and Myanmar (3) were sub-national.
O’Connell K, Gatakaa H, Poyer S, et al. 2011. Got ACTs? Availability, price, market share and provider knowledge of anti-malarial medicines in
public and private sector outlets in six malaria-endemic countries. Malaria Journal, 10: 326.
Tougher S, the ACTwatch Group, Ye Y, et al. 2013. Effect of the Affordable Medicines Facility-malaria (AMFm) on the availability, price, and
market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data.
Lancet, 380: 1916-26.
7 Palafox B, Patouillard E, Tougher S, et al. 2014. Understanding private sector antimalarial distribution chains: a cross-sectional mixed methods
study in six malaria-endemic countries. PLoS One, 9(4).
8 Littrell M, Gatakaa H, Evance I, et al. (2011). Monitoring fever treatment behavior and equitable access to effective medicines in the context
of initiatives to improve ACT access: baseline results and implications for programming in six African countries. Malaria Journal, 10: 327.
6
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ACTwatch in Kenya
PSI conducted two rounds of outlet surveys in 2010 and 2011 in Kenya as part of the Independent Evaluation of the
AMFm through support from the Global Fund. A follow-up outlet survey was conducted in 2014.
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Annex 2: Kenya Background
The Republic of Kenya is a country in East Africa and is bordered by Ethiopia, Sudan, Uganda, Tanzania and Somalia. It
covers an area of 582,646 square kilometers, of which about 80% of the land area is arid and semi‐arid and only 20%
is arable.9 It is divided into eight provinces, which are further subdivided into districts, divisions, locations, and sub‐
locations. According to the 2009 census, the population of Kenya was 38.6 million,10 and more recent World Bank
figures estimate the population reached 44.86 million in 2014.11 In 2009, 42.9% of the population was aged below 15
years, and 67.7% lived in rural areas.12
Kenya is a lower middle-income country with a gross domestic product per capita of US $ 1,358.3 per capita in 2014,
and an economy that is predominantly agrarian.13 The human development index is 0.535, ranking the country 147th
out of 187 countries. Kenya experiences strong regional disparities in poverty as well as high rates of inequality of
income distribution, particularly in urban areas.
Health care system
Kenya’s health care system consists of a network of more than 6,700 health facilities countrywide, with the public
sector accounting for half of facilities.14 There has been a general increase in the number of healthcare personnel over
the years and there was an average of 20.7 doctors and 159.3 nurses for every 100,000 persons by 2013.15 The public
sector accounts for 60% of total health personnel, of whom about 70% are concentrated in hospitals.16 Kenya has two
line of ministries responsible for health care delivery – the Ministry of Medical Services (MOMS) and the Ministry of
Public Health and Sanitation (MOPHS) that together have the mandate to implement the National Health Sector
Strategic Plan.
Health services delivery is now organized with a focus on community delivery systems with community health units
responsible for services at the community level. Community health units refer to primary care services provided at
dispensaries and health centers at the sub-county level. Referral services are available at the county and national
levels.17
The private for‐profit health sector is comprised of private hospitals, clinics, dispensaries and drug outlets and accounts
for about one-third of health facilities in the country.18
Malaria risk and burden
Approximately 75 percent of Kenya’s population resides in areas with malaria transmission (population of 33.7 million
people), with 36 percent residing in areas of high transmission and 40% residing in areas of low transmission. In recent
years, Kenya has experienced significant declines in malaria admissions and deaths at the national level. High malaria
transmission is concentrated in the endemic areas around Lake Victoria.19
9
MOPHS. (2009). Towards a malaria-free Kenya: National Malaria strategy 2009-2017. Available: http://www.chubonline.org/sites/default/files/resources/main/Kenya_National_Malaria_Strategy_2009-2017.pdf.
10 KNBS. (2010). The 2009 Kenya Population and Housing Census: Volume 1c.
Nairobi, Kenya: KNBS.
11 The World Bank (2015). Available: http://data.worldbank.org/indicator/SP.POP.TOTL/countries/KE?display=graph.
12
Kenya National Bureau of Statistics (KNBS). (2010). The 2009 Kenya population and Housing Census: Volume 1c.
Nairobi, Kenya: KNBS.
13 The World Bank (2015). Available: http://data.worldbank.org/indicator/NY.GDP.PCAP.CD.
14 Division of Malaria Control [Ministry of Public Health and Sanitation]. (2010). National guidelines for the diagnosis, treatment and prevention of malaria in
Kenya. Nairobi, Kenya: DOMC.
15 Ministry of Health. (2014). Kenya Health Policy 2014-2030: Towards attaining the highest standard of health. Nairobi, Kenya: Ministry of Health
16 Wamai R. G. (2009). The Kenya Health System – Analysis of the situation and enduring challenges. JMAJ 52(2): 134–140
17
Ministry of Health. (2014). Kenya Health Policy 2014-2030: Towards attaining the highest standard of health. Nairobi, Kenya: Ministry of Health
18 DOMC [MOPHS]. (2010). National guidelines for the diagnosis, treatment and prevention of malaria in Kenya. Nairobi, Kenya: DOMC
19 WHO. (2014). World Malaria Report 2014. WHO: Geneva.
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Figure X1: Map of confirmed cases per 1000 population / parasite prevalence
Source: Noor et al. (2009). The risks of malaria infection in Kenya in 2009, p. 9.
Kenya has four malaria epidemiological zones that are largely defined by altitude, rainfall patterns and temperature.
These areas include:
1. Endemic areas around Lake Victoria in Western Kenya and in the Coastal regions. Transmission in these areas is
intense throughout the year, but peaks from June to August and again in late November following the rainy seasons.
2. Seasonal transmission areas. These are arid and semi‐arid areas of the northern and south-eastern parts of the
country, which experience short periods of intense transmission during the rainy season.
3. Epidemic prone areas of Western highlands of Kenya. Malaria transmission here is seasonal with considerable year‐
to‐year variation. Case fatality rates during an epidemic can be up to ten times greater than those experienced in
regions where malaria occurs regularly.
4. Low risk malaria areas. This zone covers the central highlands of Kenya including Nairobi, where temperatures are
too low to allow completion of the sporogenic cycle of the malaria parasite in the vector.
Malaria case management guidelines
Diagnosis
The national guidelines for malaria case management were updated in 2010 to recommend universal parasitological
testing of all febrile patients in all areas of the country (regardless of endemicity) with malaria microscopy or RDTs.
However, the guidelines noted that where confirmatory testing is not available, suspected malaria cases should not
be denied antimalarial treatment.20 The first nationwide distribution of RDTs took place in 2012, following initial sub-
20
MOPHS (2010) National Guidelines for Diagnosis, Treatment and Prevention of Malaria for Health Workers. Third Edition. Ministry of Public Health and
Sanitation & Ministry of Medical Services, Division of Malaria Control, Nairobi.
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national pilot projects implemented since 2006.21 A major RDT stockout occurred in 2013 after a central warehouse
fire in January destroyed over 4.2 million RDTs. A PMI procurement of 4.5 million RDTs arrived in March 2014 and RDTs
were rolled out to community, dispensary and health centers.22 Access to diagnostic testing services is being expanded
through the provision of RDTs to facilities that do not have microscopy. It is expected that with increased access to
RDTs, provided through a Global Fund Round 10 Grant, rational use of ACTs will improve – thereby increasing access
by decreasing demand.23
Treatment
In 2004, Kenya changed its first-line treatment policy for uncomplicated malaria from SP to artemether lumefantrine
(AL) 20/120.24 In 2010, the treatment policy was revised to recommend dihydroartemisinin piperaquine (DHA PPQ)
for the second-line treatment and the use of AL during the second and third trimesters of pregnancy.25
Results of nationally representative biannual surveys to monitor outpatient malaria case management by the DOMC
between 2010 and 2013 showed that availability of at least one AL pack was relatively high (range: 89.1%–97.2%),
however, facilities less commonly had all four packs in stock (range: 45.4–71.5%).26
Financing and major initiatives to improve case management
In the Kenya Malaria Strategy 2009-2017, the malaria case management objective is to have 100 percent of all
suspected malaria cases presenting to a health provider managed according to the national malaria treatment
guidelines by 2017. Strategies to achieve this objective include: 27
1) Capacity building of health workers in malaria diagnosis and treatment at health facilities
2) Access to affordable malaria medicines and diagnostics through the private sector
3) Strengthening community case management of malaria using the community strategy through community
health workers
4) Ensuring commodity security of antimalarials and diagnostics in the public sector
Kenya has implemented strategies to increase access to malaria blood testing and appropriate treatment with funding
through the Affordable Medicines Facility, malaria (AMFm) and Global Fund Round 10 as well as support from DFID
and the US President’s Malaria Initiative (PMI). The AMFm provided first-line buyers in the public and private sector
with access to highly subsidized (co-paid) quality-assured ACTs. Medicines subsidized through the AMFm are marked
with a ‘green leaf’ logo on the packaging. Phase 1 of the AMFm was implemented from 2010-2012. Kenya signed the
AMFm grant in July 2010. Copaid ACTs arrived in-country for the private sector by August of 2010 and for the public
sector by June of 2011. By the end of 2011, the number of copaid QA ACT treatments delivered to Kenya was
approximately 14.35 million in the public sector and 14.1 million in the private sector. The independent evaluation of
the AMFm in Kenya showed a successful increase in availability and market share for quality-assured ACTs. The median
price for QA ACTs in the private sector fell dramatically between baseline and endline and the price was equal to that
21
Zurovac D, Githinji S, Memusi D, et al. (2014). Major improvements in the quality of malaria case-management under the “test and treat” policy in Kenya.
PLoS One, 9(3): e92782.
22
PMI. (2015). Malaria Operational Plan 2015. Available: http://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy15/fy-2015-kenya-malaria-operational-plan.pdf?sfvrsn=3.
23
Key informant interviews conducted in December 2014.
24 Amin AA, Zurovac D, Kangwana BB, Greenfeld J, Otieno DN, et al. (2007) The challenges of changing national malaria drug policy to artemisinin-based
combinations in Kenya. Malar J 6: 72.
25
MOPHS. (2010). National Guidelines for Diagnosis, Treatment and Prevention of Malaria for Health Workers. Third Edition. Ministry of Public Health and
Sanitation & Ministry of Medical Services, Division of Malaria Control, Nairobi.
26
Zurovac D, Githinji S, Memusi D, et al. (2014). Major improvements in the quality of malaria case-management under the “test and treat” policy in Kenya.
PLoS One, 9(3): e92782.
27 MOPHS. (2009). Towards a malaria-free Kenya: National Malaria strategy 2009-2017. Available: http://www.chubonline.org/sites/default/files/resources/main/Kenya_National_Malaria_Strategy_2009-2017.pdf.
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of the most popular non-artemisinin therapy, SP.28 Transitional funding was provided by DFID in Kenya for co-paid
ACTs through 2014.
Kenya switched from a combined “push-pull” procurement system to a “pull” system based on AL consumption in
2012. This shift has been supported with activities to strengthen logistics and management information systems as
well as various approaches to mitigate stock-outs as peripheral levels.29 Kenya has not experienced a stockout of AL at
the central level for more than three years, which is an improvement over previous years when nationwide stockouts
occurred regularly.30
28
AMFm Independent Evaluation Team. (2012). Independent evaluation of Phase 1 of the Affordable Medicines Facility – malaria (AMFm), multi-country
independent evaluation report: Final report. Calverton MD and London: ICF International and London School of Tropical Medicine and Hygiene.
29 Zurovac D, Githinji S, Memusi D, et al. (2014). Major improvements in the quality of malaria case-management under the “test and treat” policy in Kenya. PLoS
One, 9(3): e92782.
30
PMI. (2015). Malaria Operational Plan 2015. Available: http://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy15/fy-2015-kenya-malaria-operational-plan.pdf?sfvrsn=3.
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Annex 3: Outlet Survey Methods
Design and Study Population
ACTwatch implements repeat cross-sectional outlet surveys in project countries. The study population is defined as all
outlets with the potential to sell or distribute antimalarial medicines and/or provide malaria blood testing. In Kenya,
this includes the following outlet types:
Public health facilities
National referral hospital, provincial general hospitals, health centers or sub-health
centers and dispensaries. There are over 3,000 MOH public health facilities in Kenya.
Private not for-profit
health facilities
Hospitals, clinics, and dispensaries operated by NGO, CBO, or faith-based
organizations. There are over 1,100 private not for-profit facilities in Kenya.
Community health
workers
Private for-profit health
facilities
Community-based health workers
Registered
pharmacies/chemists
Pharmacies/Chemists are licensed and regulated by the Registered Pharmacy and
Poisons Board and include Pharmacist Premises. By 2013, there were over 4,100
registered Pharmacies/Chemists in Kenya.
Small businesses that are not registered with the Registered Pharmacy and Poisons
Board, but sell various classes of prescription and over-the-counter medicine at
commercial prices.
Unregistered pharmacies
Private hospitals, clinics, dispensaries, and diagnostic laboratories. There are over
3,100 private for-profit health facilities in Kenya.
General retailers
Supermarkets, duka, kiosks, market stalls, and petrol stations.
Itinerant drug vendors
Mobile providers typically working within a radius of their home. They are not
registered with any national regulatory authority.
Stratification
The Kenya 2014 outlet survey is stratified to provide estimates for urban and rural domains. Urban and rural
designations for all sub-counties in the sampling frame were obtained from the 1999 National Census classification of
enumeration areas. Locations with 65% or greater population living in areas classified as urban or peri-urban were
classified as urban. All other locations were classified s rural.
Eligibility Criteria
All outlets with the potential to sell or distribute antimalarials were included in the census screening. Outlets were
eligible for a provider interview and malaria product audit if they met at least one of three study criteria: 1) one or
more antimalarials reportedly in stock the day of the survey; 2) one or more antimalarials reportedly in stock within
the three months preceding the survey; and/or 3) provides malaria blood testing (microscopy or RDT). Outlets that
do not serve the general public (e.g. military facilities) were excluded from the study.
Sample Size
The outlet survey was powered to detect a 20 percentage point increase between 2011 and 2014 within each research
domain (and nationally) in the indicator, the proportion of outlets that have quality-assured ACT in stock among all
outlets with antimalarials in stock at the time of the survey. The required sample size for each research domain (urban
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and rural strata) was calculated in three steps: 1) determine the required number of antimalarial-stocking outlets; 2)
determine the number of outlets to be enumerated to arrive at this number of antimalarial-stocking outlets; and 3)
determine the number of clusters for the census to arrive at this number of outlets.
Required number of antimalarial-stocking outlets
The number of antimalarial-stocking outlets required to detect a change over time in availability of ACT between survey
rounds is given by:
n = deff éë Za 2P(1- P) + Z1-b P1 (1- P1 ) + P2 (1- P2 ) ùû
2
(P2 - P1 )2
where:



n=
P1=
P2=
desired sample size
the proportion of antimalarial-stocking outlets with quality assured ACT in stock in 2011
the expected proportion of antimalarial-stocking outlets with quality-assured ACT in stock in 2014



P=
Zα/2=
Z1-β=
(P1+P2)/2
The standard normal deviate value for a α type I error (two-sided)
The standard normal deviate value for a β type type II error

Deff=
design effect anticipated due to the cluster survey design. Design effects observed during the 2011 study
were used for sample size calculations.
The required size for the 2014 survey was calculated based on the following values of P1 and deff, estimated from the
2011 AMFm Independent Evaluation outlet survey:
P1
deff
Urban Domain
0.719
6.5
Rural Domain
0.634
6.4
In addition, the following values for key parameters were used:
Zα/2 = 1.96, corresponding to an α (type I) error of 5% with a two-sided test
Z1-β = 0.84, corresponding to a test power of 80% (or a type II error of 20%)
The required numbers of antimalarial stocking outlets, calculated using the above formula, are 594 outlets in the urban
domain and 617 outlets in the rural domain.
The same formula was used to calculate the number of public health facilities and pharmacies required to detect
change over time within each of these outlet types, in urban and rural areas. In 2011, QA ACT availability within these
outlet types was observed as follows: urban public health facility: 0.920; rural public health facility: 0.974; urban
Registered Pharmacy: 0.933. With a design effect of 2.0 in all cases, 114 urban and 84 rural public health facilities are
required, and 107 urban pharmacies and 127 rural pharmacies are required.
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Required number of antimalarial-stocking outlets
The following formula was used to calculate the required number of enumerated outlets:
N = n / Pam
where:
N=
the required number of outlets enumerated
n=
the number of antimalarial stocking outlets
Pam= the proportion of outlets having any antimalarial in stock at the time of the survey among all outlets
enumerated
The table below presents the estimates for Pam from the 2010 outlet survey and the required gross sample sizes
calculated using the above formula.
Urban Domain
Rural Domain
n
594
617
Pam
0.15
0.18
N
3,960
3,427
Thus a total of 3,960 outlets in the urban domain and 3,428 outlets in the rural domain must be interviewed in order
to detect a 20 percentage point change in QA ACT availability between the 2014 and 2016 outlet surveys. During the
2011 national outlet survey, 90% of urban outlets and 79% of rural outlets enumerated were successfully screened,
with reasons for non-participation including outlet temporary or permanent closure, non-availability due to busy
providers, and refusal. Taking these non-participation rates into account, the total number of outlets required for
enumeration is: 4,362 urban and 4,343 rural.
Required number of clusters (location)
The primary sampling approach entails sampling a set of administrative units (geographic clusters) with a
corresponding population of approximately 10,000 to 15,000 inhabitants. The appropriate administrative unit in Kenya
corresponding to this desired population size is location. The desired number of clusters (wards) is selected with
probability of cluster selection proportionate to size (PPS). A census of all outlets with the potential to sell or distribute
antimalarials will be conducted in sampled wards.
The average number of outlets screened per cluster from the 2011 outlet survey was used to estimate the number of
clusters required in 2014 to achieve the desired sample size. The following formula was used to calculate the required
number of clusters:
𝐶 = 𝑁/𝑂̅
where:
C=
the required number of clusters
N=
the number of enumerated outlets
̅=
O
the mean number of outlets per cluster
̅ from the 2010/11 outlet survey and the required number of clusters
The table below presents the estimates for O
required using the above formula.
Urban Domain
Rural Domain
N
4,362
4,343
̅
320.1
160.9
O
C
14
27
The 2011 survey findings suggest that on average, each urban location will have 2.3 public health facilities and 2.5
pharmacies. In order to achieve a sufficiently large sample size of urban public health facilities and pharmacies using
the census Location plus Division booster strategy, the optimal number of urban Locations was calculated at 26.
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Thus a total of 26 urban and 27 rural clusters will be censused in order to detect a 20 percentage point change in QA
ACT availability between the 2014 and 2016 outlet surveys, and to achieve sufficient sample sizes for public health
facilities and pharmacies to allow for estimates within these key outlet types.
Applying the above parameters to the stated formula yields the following required sample sizes: urban: 268; rural 813;
total: 1,081.
Sampling
The primary sampling approach taken for outlet surveys entails sampling a set of administrative units (geographic
clusters) with a corresponding population of approximately 10,000 to 15,000 inhabitants. The appropriate
administrative unit in Kenya corresponding to this desired population size is Location. A representative sample of
Locations was selected and a census of all outlets with the potential to sell or distribute antimalarials was conducted
in sampled Locations. A ‘booster’ sample was used to increase the sample size for certain outlet types. The booster
sample was drawn from the Divisions in which sampled Locations were located. Within booster sample Divisions, a
census of the following outlet types was conducted: public health facilities and registered pharmacies.
The sampling frame was generated using information from the 1999 National Census. Locations were defined as urban
or rural according to information in the sampling frame provided at enumeration area (EA) level. The National Census
classified EAs as urban, peri-urban, or rural. At the Location level, Locations with 65% or greater population living in
areas classified as urban or peri-urban were classified as urban. All other locations were classified as rural. Clusters
with recent documented security risks were excluded from sampling framework and these included all clusters in
former North-Eastern Province and as well as clusters in former Coast Provinces (Tana River and Lamu).
A representative sample of Locations was selected in each research domain (urban and rural areas) using one-stage
cluster sampling. Two lists were prepared: a list of all urban Locations and a list of all rural Locations. The lists were
sorted alphabetically by Province, District, Division, and Location and 26 urban and 27 rural Locations were sampled
with probability proportional to population size (PPS). Selected/sampled locations with high population size of
>40,000 persons were segmented into smaller units (sub-locations) and one sub-location was selected for the survey.
The list of selected Locations is included in Annex 4.
In these sampled locations, a census was conducted among all outlets with potential to stock antimalarials or/and
provide malaria blood testing. In addition to the census of selected Locations, a booster sample was employed for
pharmacies and public health facilities to reach the desired sample size for these key market segments. The booster
strategy for public health facilities and pharmacies was to census all facilities and pharmacies within the Division of
the sampled Location (i.e. expand the geographic scope for the census).
Data Collection
Interviewers, supervisors, and quality controllers received training that included an orientation to the study,
questionnaire and use of PDAs, classroom training on completing antimalarial and RDT audits, and a field exercise.
Following training, data collection was implemented from November 7 to December 22, 2014.
For all interviews, a structured questionnaire was administered using paper questionnaires (see Annex 6). A series of
screening questions were administered at all outlets to determine eligibility for the survey. Outlets where antimalarial
medicines were reportedly sold and/or malaria blood testing was reportedly provided were invited to participate in
the survey. Following informed consent procedures, an audit of all available antimalarial medicines and RDTs was
conducted. Antimalarial audit information included formulation, package size, brand name, active ingredients and
strengths, manufacturer, country of manufacture, reported sale/distribution in the week preceding the survey, retail
price, and wholesale price. RDT audit information included brand name, manufacturer, country of manufacture,
reported sale/distribution in the week preceding the survey, retail price, and wholesale price. Detailed descriptions of
antimalarials and RDTs audited are provided in Annex 7 and Annex 8. In addition to the product audit, a series of
questions was administered to the senior-most provider regarding malaria case management knowledge and practices
as well as provider training and qualifications. Geo-coordinates were recorded for each outlet using a handheld Global
Positioning System (GPS) unit.
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Up to three visits were made to all outlets to complete the screening process, audit, and provider interviews as needed
(e.g. where outlets were closed or providers were not available).
Data Entry, Processing, and Analysis
Data was collected using paper questionnaires and entered using Microsoft Access. All data cleaning and analysis was
completed using Stata 13.1 (©StataCorp, College Station, TX). Sampling weights were applied to account for variations
in probability of selection (see Annex 9) and standard error estimation accounted for clustering at the location and
division levels. Indicator definitions are provided in Annex 10.
Protection of Human Subjects
Ethical approval was obtained from the Kenyatta National Hospital Ethics and Research Committee (KNH ERC) prior to
conducting the study. The PSI Research Ethics Board ceded review to the committee in Kenya. Provider interviews and
product audits were completed only after administration of a standard informed consent form and provider consent
to participate in the study. Providers had the option to end the interview at any point during the study. Standard
measures were employed to maintain provider confidentiality and anonymity.
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Annex 4: Sampled Locations
Table X1. Sampled locations
Province
District
Division
Location
Urban/Rural Population
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
KIAMBU
KIAMBU
KIAMBU
KIAMBU
KIAMBU
KIAMBU
KIAMBU
KIAMBU
KIAMBU
KIRINYAGA
KIRINYAGA
KIRINYAGA
KIRINYAGA
MURANG'A
MURANG'A
MURANG'A
MURANG'A
NYERI
NYERI
NYERI
NYERI
NYERI
THIKA
THIKA
THIKA
THIKA
THIKA
THIKA
THIKA
THIKA
THIKA
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
KWALE
MOMBASA
MOMBASA
MOMBASA
MOMBASA
MOMBASA
MOMBASA
MOMBASA
KIKUYU
KIKUYU
KIKUYU
KIKUYU
KIKUYU
KIKUYU
KIKUYU
KIKUYU
KIKUYU
CENTRAL
CENTRAL
CENTRAL
CENTRAL
KAHURO
KAHURO
KAHURO
KAHURO
KIENI EAST
KIENI EAST
KIENI EAST
KIENI EAST
KIENI EAST
KAKUZI
KAKUZI
KAKUZI
KAKUZI
MUNICIPALITY
MUNICIPALITY
MUNICIPALITY
MUNICIPALITY
MUNICIPALITY
KUBO
KUBO
KUBO
KUBO
KUBO
KUBO
MSAMBWENI
MSAMBWENI
MSAMBWENI
MSAMBWENI
MSAMBWENI
MSAMBWENI
MSAMBWENI
MSAMBWENI
MSAMBWENI
MSAMBWENI
MSAMBWENI
MSAMBWENI
MSAMBWENI
CHANGAMWE
CHANGAMWE
CHANGAMWE
CHANGAMWE
CHANGAMWE
KISAUNI
KISAUNI
KINOO - Uthiru Sub-Loc
KINOO - Gitiba Sub-Loc
KINOO - Kinoo Sub-Loc
KINOO - Thogoto Sub-Loc
KABETE
KARAI
KIKUYU
MUGUGA
NYATHUNA
KUTUS
INOI
KERUGOYA
KOROMA
MUGOIRI
KAHUHIA
MURARANDIA
WEITHAGA
GAKAWA
KABARU
KIAMATHAGE
NAROMORU
THIGU
MITUMBIRI
ITHANGA
KAKUZI
SAMURU
THIKA MUNICIPAL- Komu Sub-Loc
THIKA MUNICIPAL - Biashara Sub-Loc
THIKA MUNICIPAL - Karimeni Sub-Loc
THIKA MUNICIPAL - Majengo Sub-Loc
GATUANYAGA
MWALUPHAMBA
LUKORE
MAJIMBONI
MANGAWANI
MKONGANI
MWALUVANGA
DIANI - Gombato Sub-Loc
DIANI - Bongwe Sub-Loc
DIANI - Ukunda Sub-Loc
DZOMBO
KIKONENI
KINGWEDE/SHIRAZ
KINONDO
LUNGA
MIVUMONI
MSAMBWENI
MWERENI
PONGWE/KIDIMU
VANGA
PORT REITZ
CHANGAMWE
KIPEVU
MIKINDANI
MIRITINI
KISAUNI - Kisauni Sub-Loc
KISAUNI - Junda Sub-Loc
urban
urban
urban
urban
urban
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
urban
urban
urban
urban
rural
rural
rural
rural
rural
rural
rural
urban
urban
urban
rural
rural
rural
rural
rural
rural
urban
rural
rural
rural
urban
urban
urban
urban
urban
urban
urban
www.ACTwatch.info
15,145
3,766
14,474
11,726
30,899
27,951
33,907
33,103
23,994
12,258
25,826
22,717
12,834
31,413
14,818
29,995
16,493
22,797
19,203
10,678
17,667
10,522
19,304
18,199
26,026
8,389
54,120
10,607
4,648
17,593
17,875
16,648
2,619
6,170
7,444
13,070
2,892
18,045
7,962
23,936
30,226
14,691
8,912
18,121
16,848
8,639
14,381
26,736
12,372
11,473
53,401
11,314
44,583
32,267
29,953
51,508
13,454
Page 112
COAST
COAST
COAST
COAST
COAST
COAST
COAST
COAST
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
EASTERN
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
MOMBASA
MOMBASA
MOMBASA
MOMBASA
MOMBASA
MOMBASA
MOMBASA
MOMBASA
EMBU
EMBU
EMBU
EMBU
ISIOLO
ISIOLO
ISIOLO
ISIOLO
MACHAKOS
MACHAKOS
MACHAKOS
MACHAKOS
MACHAKOS
MAKUENI
MAKUENI
MAKUENI
MAKUENI
MAKUENI
MAKUENI
MBEERE
MBEERE
MBEERE
MBEERE
MERU CENTRAL
MERU CENTRAL
MERU CENTRAL
MERU CENTRAL
MERU CENTRAL
MERU CENTRAL
MERU NORTH
MERU NORTH
NITHI (MERU S.)
NITHI (MERU S.)
NITHI (MERU S.)
NITHI (MERU S.)
NITHI (MERU S.)
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
KISAUNI
KISAUNI
KISAUNI
LIKONI
LIKONI
LIKONI
LIKONI
LIKONI
MANYATTA
MANYATTA
MANYATTA
MANYATTA
CENTRAL
CENTRAL
CENTRAL
CENTRAL
KANGUNDO
KANGUNDO
KANGUNDO
KANGUNDO
KANGUNDO
KATHONZWENI
KATHONZWENI
KATHONZWENI
KATHONZWENI
KATHONZWENI
KATHONZWENI
GACHOKA
GACHOKA
GACHOKA
GACHOKA
MIRIGA MIERU E.
MIRIGA MIERU E.
MIRIGA MIERU E.
MIRIGA MIERU E.
MIRIGA MIERU E.
MIRIGA MIERU E.
MUTUATI
MUTUATI
MWIMBI
MWIMBI
MWIMBI
MWIMBI
MWIMBI
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
CENTRAL
DAGORETTI
DAGORETTI
DAGORETTI
DAGORETTI
DAGORETTI
DAGORETTI
EMBAKASI
EMBAKASI
EMBAKASI
EMBAKASI
EMBAKASI
EMBAKASI
KISAUNI - Magogoni Sub-Loc
BAMBURI
KONGOWEA
LIKONI - Likoni Sub-Loc
LIKONI - Bofu Sub-Loc
LIKONI - Timbwani Sub-Loc
MTONGWE
SHIKA ADABU
NGANDORI
GATURI NORTH
NGINDA
RUGURU
ISIOLO EAST
CENTRAL
ISIOLO WEST
NGARE MARA
KANZALU
KAKUYUNI
KANGUNDO
KAWETHEI
KIVAANI
KITISE
KANTHUNI
KATHONZWENI
KITHUKI
MAVINDINI
MBUVO
MAVURIA
KIAMBERE
KIANJIRU
MBETI SOUTH
THUURA
CHUGU
GIAKI
KIBURINE
MULATHANKARI
MUNITHU
KABACHI
NAATHU
GANGA
CHOGORIA
KIERA
MAARA
MURUGI
MATHARE - Mathare Sub-Loc
MATHARE - Mabatini Sub-Loc
MATHARE - Mlango Kubwa Sub-Loc
HURUMA
KARIOKOR
NGARA
STAREHE
MUTUINI
KAWANGWARE
KENYATTA/GOLF C
RIRUTA
UTHIRU/RUTHMITU
WAITHAKA
EMBAKASI
UMOJA - Savannah Sub-Loc
UMOJA - Umoja Sub-Loc
DANDORA
KARIOBANGI S.
KAYOLE
urban
urban
urban
urban
urban
urban
urban
urban
rural
rural
rural
rural
urban
urban
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
urban
urban
rural
rural
urban
urban
rural
rural
rural
rural
rural
rural
rural
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
www.ACTwatch.info
45,565
39,687
86,581
15,054
24,924
18,584
20,507
14,270
22,342
12,324
27,836
9,022
10,416
23,084
11,409
6,334
18,381
15,776
28,306
15,644
13,130
8,495
7,787
17,998
9,605
12,810
8,997
17,259
10,860
17,479
13,953
9,608
12,759
7,540
6,619
11,103
9,444
34,110
22,221
16,170
14,587
9,042
10,907
13,368
25,501
17,260
25,986
87,386
33,975
24,158
14,151
14,534
86,884
28,528
65,987
23,250
20,142
22,982
30,206
62,666
109,438
17,467
98,125
Page 113
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
NAIROBI
GUCHA(S. KISII)
GUCHA(S. KISII)
KISII CENTRAL
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
KISUMU
N.KISII(NYAMIRA
N.KISII(NYAMIRA
N.KISII(NYAMIRA
N.KISII(NYAMIRA
N.KISII(NYAMIRA
N.KISII(NYAMIRA
N.KISII(NYAMIRA
N.KISII(NYAMIRA
N.KISII(NYAMIRA
EMBAKASI
EMBAKASI
EMBAKASI
KASARANI
KASARANI
KASARANI
KASARANI
KASARANI
KASARANI
KASARANI
KASARANI
KIBERA
KIBERA
KIBERA
KIBERA
KIBERA
KIBERA
KIBERA
KIBERA
KIBERA
KIBERA
KIBERA
PUMWANI
PUMWANI
PUMWANI
PUMWANI
PUMWANI
WESTLANDS
WESTLANDS
WESTLANDS
WESTLANDS
WESTLANDS
WESTLANDS
WESTLANDS
WESTLANDS
OGEMBO
OGEMBO
TOWNSHIP
KADIBO
KADIBO
KADIBO
KADIBO
WINAM
WINAM
WINAM
WINAM
WINAM
WINAM
WINAM
WINAM
WINAM
WINAM
WINAM
WINAM
EKERENYO
EKERENYO
EKERENYO
EKERENYO
EKERENYO
EKERENYO
EKERENYO
EKERENYO
NYAMIRA
MUKURU KWA NJEN
NJIRU
RUAI
KARIOBANGI - Kariobangi North Sub-Loc
KARIOBANGI - Baba Dogo Sub-Loc
GITHURAI
KAHAWA
KASARANI
KOROGOCHO
ROYSAMBU
RUARAKA
KIBERA - Makina Sub-Loc
KIBERA - Kibera Sub-Loc
KIBERA - Lindi Sub-Loc
KIBERA - Silanga Sub-Loc
SERA NGOMBE - Olympic Sub-Loc
SERA NGOMBE - Gatwikira Sub-Loc
KAREN
LAINI SABA
LANGATA
MUGUMOINI
NAIROBI WEST
BAHATI
EASTLEIGH NORTH
EASTLEIGH SOUTH
KAMUKUNJI
PUMWANI
HIGHRIDGE - Karura Sub-Loc
HIGHRIDGE - Highridge Sub-Loc
HIGHRIDGE - Muthaiga Sub-Loc
KANGEMI
KILIMANI
KITISURU
LAVINGTON
PARKLANDS
SENGERA
M/CHACHE
TOWNSHIP
KOMBURA
BWANDA
KAWINO
KOCHIENG'
S.W. KISUMU
CENTRAL KISUMU
CENTRAL KOLWA
EAST KAJULU
EAST KISUMU
EAST KOLWA
KONDELE
MIWANI
NORTH KISUMU
TOWNSHIP
WEST KAJULU
WEST KOLWA
EKERENYO - Boisanga II Sub-Loc
EKERENYO - Boisanga I Sub-Loc
EKERENYO - Bokurati I Sub-Loc
EKERENYO - Bokurati II Sub-Loc
EKERENYO - Ikonge Sub-Loc
BOMWAGAMO
KIABONYORU
N. MUG. CHACHE
BONYAMATUTA CHA
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
urban
rural
rural
urban
rural
rural
rural
rural
urban
urban
urban
urban
urban
urban
urban
rural
urban
urban
urban
urban
rural
rural
rural
rural
rural
rural
rural
rural
urban
www.ACTwatch.info
62,271
17,730
12,461
31,905
39,373
48,168
32,272
37,620
44,141
27,492
79,079
32,450
16,082
17,859
16,643
21,454
24,209
8,879
51,896
16,015
29,604
41,868
39,098
66,758
50,390
18,154
20,074
14,826
25,050
6,723
59,125
44,312
27,790
18,818
11,365
30,933
47,827
34,956
11,759
7,620
12,119
17,284
18,845
15,028
19,615
11,919
27,633
15,580
69,225
8,142
16,210
40,083
17,174
66,953
7,216
9,808
6,765
4,767
14,710
14,143
35,179
40,720
21,903
Page 114
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
NYANZA
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
N.KISII(NYAMIRA
N.KISII(NYAMIRA
N.KISII(NYAMIRA
N.KISII(NYAMIRA
N.KISII(NYAMIRA
N.KISII(NYAMIRA
RACHUONYO
RACHUONYO
RACHUONYO
RACHUONYO
RACHUONYO
RACHUONYO
RACHUONYO
RACHUONYO
RACHUONYO
RACHUONYO
RACHUONYO
BARINGO
BARINGO
BARINGO
BARINGO
BURET
BURET
BURET
BURET
BURET
KAJIADO
KAJIADO
KAJIADO
KAJIADO
KAJIADO
KAJIADO
KAJIADO
KAJIADO
KAJIADO
KERICHO
KERICHO
KERICHO
KERICHO
KERICHO
KERICHO
KERICHO
KERICHO
NAKURU
NAKURU
NAKURU
NAKURU
NAKURU
NAKURU
NAKURU
NAKURU
NAKURU
NAKURU
NAKURU
NAKURU
NAKURU
NAKURU
NAKURU
NAROK
NAROK
NAROK
NAROK
NAROK
NYAMIRA
NYAMIRA
NYAMIRA
NYAMIRA
NYAMIRA
NYAMIRA
KASIPUL
KASIPUL
KASIPUL
KASIPUL
KASIPUL
KASIPUL
KASIPUL
KASIPUL
KASIPUL
KASIPUL
KASIPUL
KOLLOWA
KOLLOWA
KOLLOWA
KOLLOWA
SOTIK
SOTIK
SOTIK
SOTIK
SOTIK
NGONG
NGONG
NGONG
NGONG
NGONG
NGONG
NGONG
NGONG
NGONG
KIPKELION
KIPKELION
KIPKELION
KIPKELION
KIPKELION
KIPKELION
KIPKELION
KIPKELION
BAHATI
BAHATI
BAHATI
BAHATI
NAKURU MUNI.
NAKURU MUNI.
NAKURU MUNI.
NAKURU MUNI.
NAKURU MUNI.
NAKURU MUNI.
RONGAI
RONGAI
RONGAI
RONGAI
RONGAI
CENTRAL
CENTRAL
MULOT
MULOT
MULOT
BOGICHORA
BONYAMATUTA MAS
BOSAMARO CHACHE
BOSAMARO MASABA
KEERA
W. MUGIRANGO
KONUONGA
EAST KAMAGAK
KACHIEN
KAKELO
KODERA
KOJWACH
KOKECH
KOKWANYO
KOWIDI
NORTH KAMAGAK
WEST KAMAGAK
TIRIOKO
KOLLOWA
LOIWAT
NGORON
KAMUNGEI
CHEMAGEL
KAPLETUNDO
KIMOLWET
MANARET
ONGATA RONGAI
C. KEEKONYOKIE
KISERIAN
MOSIRO
N. KEEKONYOIKE
NGONG
NKAIMORONYA
OLOOLUA
S. KEEKONYOKIE
CHEPSEON
BARSIELE
KAMASIAN
KAPSEGER
KIMUGUL
KIPCHORAN
KIPSEGI
LESIRWA
DUNDORI
BAHATI
KABAZI
SOLAI
CENTRAL - Afraha Sub-Loc
CENTRAL - Baharini Sub-Loc
BARUTI
KAPTEMBWO
LAKE NAKURU
LANET
RONGAI
BOROR
KAMPI YA MOTO
LENGINET
MAKONGENI
LOWER MELILI
NKARETA
SOGOO
ENELERAI
ILMOTIOK
rural
urban
rural
rural
urban
urban
rural
urban
rural
rural
rural
rural
urban
rural
urban
rural
urban
rural
rural
rural
rural
rural
rural
rural
rural
rural
urban
rural
rural
rural
rural
urban
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
urban
urban
urban
urban
urban
urban
rural
rural
rural
rural
rural
urban
rural
rural
rural
rural
www.ACTwatch.info
16,789
15,963
16,937
15,739
19,120
27,168
8,268
12,991
7,583
14,658
13,018
15,941
7,929
8,659
12,165
13,313
15,626
2,249
5,199
3,049
4,484
14,717
22,860
8,661
7,433
6,491
23,849
9,216
16,441
3,200
12,007
15,767
36,242
17,734
12,680
10,832
4,253
10,702
9,206
9,494
6,873
8,360
4,420
35,384
53,746
26,815
28,359
27,706
51,491
9,331
109,956
763
36,648
15,367
10,687
18,353
16,959
15,529
29,599
11,295
17,943
8,832
10,960
Page 115
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
R/VALLEY
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
WESTERN
NAROK
NAROK
TRANS NZOIA
TRANS NZOIA
TRANS NZOIA
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
UASIN GISHU
BUNGOMA
BUNGOMA
BUNGOMA
BUNGOMA
BUNGOMA
BUNGOMA
BUNGOMA
BUNGOMA
BUTERE/MUMIAS
BUTERE/MUMIAS
BUTERE/MUMIAS
BUTERE/MUMIAS
BUTERE/MUMIAS
BUTERE/MUMIAS
BUTERE/MUMIAS
KAKAMEGA
KAKAMEGA
LUGARI
LUGARI
LUGARI
LUGARI
VIHIGA
VIHIGA
VIHIGA
VIHIGA
MULOT
MULOT
KWANZA
KWANZA
KWANZA
KESSES
KESSES
KESSES
KESSES
KESSES
KESSES
KESSES
KESSES
KESSES
KESSES
SOY
SOY
SOY
SOY
SOY
SOY
SOY
SOY
SOY
KIMILILI
KIMILILI
KIMILILI
KIMILILI
NDIVISI
NDIVISI
NDIVISI
NDIVISI
KHWISERO
KHWISERO
KHWISERO
KHWISERO
KHWISERO
KHWISERO
KHWISERO
MUNICIPALITY
MUNICIPALITY
LIKUYANI
LIKUYANI
LIKUYANI
LIKUYANI
TIRIKI WEST
TIRIKI WEST
TIRIKI WEST
TIRIKI WEST
MULOT
SAGAMIAN
KAPOMBOI
KAISAGAT
KWANZA
TARAKWA
CHEPTIRET
CHUIYAT
KAPKOI
KESSES
KIPCHAMO
MEGUN
OL'LEINGUSE
TIMBOROA
TULWET
SEGERO
KIBULGENY
KIPLOMBE
KIPSOMBA
KOISAGAT
MOI'S BRIDGE
SIRIKWA
SOY
ZIWA
KIMILILI
KAMUKUYWA
KIBINGEI
MAENI
CHETAMBE
LUKUSI
NAMARAMBI
NDIVISI
WEST KISA
CENTRAL KISA
EAST KISA
KISA SOUTH
MULWANDA
NORTH KISA
SHIROMBE
BUKHUNGU
SHIEYWE
LIKUYANI
KONGONI
NZOIA
SINOKO
GISAMBAI
BANJA
JEPKOYAI
TAMBUA
rural
rural
rural
rural
rural
urban
rural
rural
rural
rural
urban
rural
rural
rural
rural
rural
urban
rural
rural
rural
rural
rural
rural
rural
urban
rural
urban
urban
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
rural
urban
urban
rural
rural
rural
rural
rural
rural
rural
rural
www.ACTwatch.info
17,330
12,853
31,051
22,452
34,862
13,863
6,196
5,381
4,034
13,311
6,159
8,364
12,754
10,009
4,645
10,082
39,925
18,002
15,747
15,686
36,018
5,457
14,617
7,883
26,886
24,241
26,825
17,598
17,723
13,803
14,969
11,546
9,747
16,584
10,009
9,359
19,546
14,081
8,742
36,511
35,048
19,824
33,530
22,269
15,922
19,884
21,871
17,515
17,070
Page 116
Annex 5: Detailed Sample Description
Table X2: Detailed sample description
Number of outlets screened (Figure 1 Box B)
Urban
Census
Booster
Rural
Census
Booster
Number of outlets eligible and interviewed (Figure 1 Box D)
Urban
Census
Booster
Rural
Census
Booster
Number of outlets eligible but not interviewed (interview nonparticipation)
Urban
Census
Booster
Rural
Census
Booster
Number of interviewed outlets with at least one antimalarial in
stock on the day of the survey (Figure 1, Box D1)
Urban
Census
Booster
Rural
Census
Booster
Number of interviewed outlets with at least one antimalarial in
stock on the day of the survey or at least one antimalarial
Public
Health
Facility
Community
Health
Workers
Private Not ForProfit Facilities
Private
for-profit
Health Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Outlets
485
182
60
122
303
68
235
477
175
57
118
302
67
235
553
293
293
0
260
260
0
58
14
14
0
44
44
0
58
34
34
0
24
24
0
50
29
29
0
21
21
0
453
351
351
0
102
102
0
407
314
314
0
93
93
0
503
454
179
275
49
23
26
492
444
175
269
48
22
26
572
469
469
0
103
103
0
557
458
458
0
99
99
0
9950
6342
6342
0
3608
3608
0
408
125
125
0
283
283
0
12676
8224
7827
397
4452
4191
261
2449
1559
1172
387
890
629
261
0
0
0
0
0
0
0
1
0
0
0
1
1
0
0
0
0
0
0
0
0
7
7
7
0
0
0
0
8
8
3
5
0
0
0
6
6
6
0
0
0
0
6
0
0
0
6
6
0
28
21
16
5
7
7
0
457
160
52
108
297
65
232
17
3
3
0
14
14
0
43
27
27
0
16
16
0
342
262
262
0
80
80
0
487
439
173
266
48
22
26
536
441
441
0
95
95
0
251
71
71
0
180
180
0
2133
1403
1029
374
730
472
258
471
52
50
375
492
557
408
2405
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Page 117
Table X2: Detailed sample description
Reportedly in stock in the previous 3 months (Figure 1 sum of
Box 1 and Box 2)
Urban
Census
Booster
Rural
Census
Booster
Number of interviewed outlets that provide malaria blood
testing, but do not stock antimalarial medicines (Figure 1 Box
D3)
Urban
Census
Booster
Rural
Census
Booster
Proportion of eligible and interviewed antimalarial-stocking
outlets with at least one provider with a health-related
qualification*
Urban
Census
Booster
Rural
Census
Booster
*
Public
Health
Facility
Community
Health
Workers
Private Not ForProfit Facilities
Private
for-profit
Health Facility
Registered
Pharmacy
Unregistered
Pharmacy
General Retailer
ALL
Outlets
171
55
116
300
65
235
12
12
0
40
40
0
29
29
0
21
21
0
285
285
0
90
90
0
444
175
269
48
22
26
458
458
0
99
99
0
125
125
0
283
283
0
1524
1139
385
881
620
261
6
4
2
2
2
2
0
6
2
2
0
4
4
0
0
0
0
0
0
0
0
32
29
29
0
3
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
44
35
33
2
9
9
0
99.78
100.00
100.00
100.00
99.66
100.00
99.57
88.24
66.67
66.67
92.86
92.86
-
100.00
100.00
100.00
100.00
100.00
-
99.12
98.85
98.85
100.00
100.00
-
99.38
99.54
100.00
99.25
97.92
100.00
96.15
97.19
98.63
98.63
90.53
90.53
-
7.29
7.14
7.14
7.34
7.34
-
88.09
94.49
92.68
99.46
75.76
62.82
99.22
Health-related qualifications include: medical doctor, pharmacist, nurse, midwife, laboratory technician, registered pharmacy technician, community health assistant, and community health worker
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Page 118
Annex 6: Questionnaire
ACTwatch Outlet Survey
Section 1: Census Information
KENYA 2014
Interviewer completes this section for all outlets.
Outlet ID Interviewer-Dist- Div-Loc -Outlet ID
C1. Today’s date (dd/mm/yyyy)
[___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
[___|___]-[___|___]-[_2_|_0_|_1_|_4_]
C2. Interviewer’s name [_____________________________________________]
C3. District
[_____________________________________________________]
C4. Division
[__________________________________________________________________]
C5. Location name
[__________________________________________________________________]
C6. Name of outlet If no name, record “no name” or owner’s name
[__________________________________________________________________]
C7. Type of Outlet
11 = NGO Hospital
01 = Public National Referral Hospital
02 = Public County Referral Hospital
03 = Public Sub-County Hospital
04 = Public Health Centre/ Sub-Health Centre
05 = Public Dispensary/ Clinic
06 = Community Health Worker
07 = Registered Pharmacy/Chemist
08 = Unregistered Registered Pharmacy/Chemist
09 = Private Hospital/Nursing Home
10 = Private Clinic/Dispensary
C2a. Interviewer’s code
[___|___]
C3a. District code
C4a. Division code
[___|___]
[___|___|___]
C5a. Location code
[___|___|___|___]
C6a. Outlet code
[___|___|___]
12 = NGO/CBO Clinic/Dispensary
13 = Mission/Faith-based Hospital
14 = Mission/Faith-based Clinic/Dispensary
15 = Supermarket/ Chain Store
16 = Duka/Kiosk/Market Stall/Petrol Station/Convenience Store
17 = Hawker
18 = Private Diagnostic Lab (Lab only)
19 = NGO/Mission Diagnostic Lab (Lab only)
96 = Other (specify) [____________________________________]
C8. Is this area part of the booster sample?
1 = Yes
0 = No
C8a. Is this outlet listed as part of PS/K private sector RDT project? (Refer to PS/K list) 1 = Yes
[___|___]
[___]
0 = No
[___]
Hello, my name is __________, I work for IPSOS on behalf of Population Services International. We are conducting a study on the availability of
antimalarial medicines and diagnostic testing services. The results will be used to improve the availability of appropriate antimalarial treatment
in Kenya. I would like to ask you a few questions to see if you could be part of the survey.
Section 2: Screening & Eligibility
S1. Do you have any medicines in stock today?
1 = Yes
Go to S3
0 = No
S2. Are there any medicines that are out of stock today, but that you stocked in the past 3 months?
1 = Yes
Go to S4
0 = No
Go to S5
8 = Don’t know Go to S5
S3. Do you have any antimalarial medicines in stock today?
1 = Yes
Provide information sheet & gain consent. Record start time in C9.
Proceed to Section 3: Antimalarial Audit.
0 = No
Verify with prompt card. Go to S4
S4. Are there any antimalarial medicines that are out of stock today, but that you stocked in the past 3 months?
1 = Yes
Provide information sheet & gain consent. Record start time in C9. Proceed to A16.
0 = No
Verify with prompt card. Go to S5
8 = Don’t know Verify with prompt card. Go to S5
S5. Are you offering any diagnostic services or selling any diagnostic tests here today?
1 = Yes
Go to S6
0 = No
Verify with prompt card. Record details in C9 then complete Sec 7: ORS & Zinc then
Sec X: Ending Interview
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[___]
[___]
[___]
[___]
[___]
Page 119
S6. Are any of these services or tests for suspected malaria?
1 = Yes
Provide information sheet & gain consent. Record start time in C9.
Proceed to Section 4: Diagnostic Audit
0 = No
Verify with prompt card. Record details in C9 then complete Sec 7: ORS & Zinc and
Sec X: Ending Interview
[___]
Before proceeding to the full interview ensure you have given the respondent a study information sheet,
explained the study and obtained informed consent.
C9. Result of Visit(s)
Date
(dd/mm/yy)
Time started
(use 24hr clock)
Time completed
(use 24hr clock)
Visit 1
Visit 2
Visit 3
[___|___]-[___|___]-[_1_|_4_] [___|___]-[___|___]-[_1_|_4_] [___|___]-[___|___]-[_1_|_4_]
[___|___]:[___|___]
[___|___]:[___|___]
[___|___]:[___|___]
[___|___]:[___|___]
[___|___]:[___|___]
[___|___]:[___|___]
Result
[___|___]
[___|___]
[___|___]
01 = Outlet eligible & survey completed
go to E1
02 = Outlet ineligible: does not meet any screening criteria
go to E1
03 = Interview interrupted
go to C11
04 = Respondent not available/time not convenient
go to C11
05 = Outlet not open at the time
go to C11
06 = Outlet closed permanently
go to E1
96 = Other (specify):[_____________________________________________________________]
97 = Refused
go to C10
C10. If the provider refused, why?
1 = Client load Ask respondent for a time they would prefer to be interviewed and note in C11
2 = Thinks it’s an inspection / nervous about license
go to E1
[___]
3 = Not interested
go to E1
6 = Other (specify):[___________________________________________________________________]
7 = Refuses to give reason go to E1
C11. Use this space to record call back details. If it is not possible to complete the interview at another time, go to E1.
Section 7: ORS & Zinc: Read to the provider: I have just a few questions for you about availability of treatments for
diarrhea.
ORS1. Do you have any oral rehydration salts, also known as ORS in stock today? Verify with prompt card.
1 = Yes
0 = No
ORS2. Do you have any zinc tablets for treatment of diarrhea in children in stock today? Verify with prompt card.
1 = Yes
0 = No Go to C9 – Results of visit
ORS3. Which strength of zinc tablets for treatment of diarrhea in children do you have in stock today?
Read list, circle ALL that apply
10mg
20mg
Other, specify :[______________________________]
ORS4. Do you have any ORS that is packaged together with zinc treatment for diarrhea in children in stock today?
Verify with prompt card
1 = Yes
0 = No
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[___]
[___]
A
B
C
[___]
Page 120
Section X: Ending the interview
E1. Name of interviewee:
5 = Not applicable, no respondent; 7 = Refused
E2. Physical address or location identifiers of outlet (not PO box)
(Give detailed description that will help supervisor to find the outlet)
[___]
E3. Telephone number
9999999995 = Not applicable: no respondent
or has no telephone
9999999997 = Refused
[___|___|___|___|___|___|___|___|___|___]
E4.Latitude: [__] -[___|___|___] .[___|___|___|___|___]
E7. Additional observations by interviewer (if any)
E5.Longitude: [_E_]-[___|___|___] .[___|___|___|___|___]
THANK THE PROVIDER AND END INTERVIEW
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Page 121
Section 3: Antimalarial Audit
A0. Read to the provider:
Can you please show us the full range of antimalarials that you currently have in stock? Do you currently have any of the
following?
Prompt entire list using antimalarial prompt card; No response to be recorded.

Artemether lumefantrine, such as Lonart, Artefan, Coartem

Artemisinin combination therapies, such as Duo-Cotexcin, Co-arinate, P-Alaxin

Artemisinin monotherapies, such as, Arinate, Artemedine

Artemether such as, Gvither

SP, such as Fansidar, Metakelfin, Ekelfin, Orodar

Amodiaquine, such as, Malaratab, Loquin

Quinine, such as, Quinitab, Quinimax, Falciquin

Mefloquine, such as Mephaquin, Meflotas, Mequin

Chloroquine, such as, Falcin, Maladrin

Syrups or suspensions, such as, Falcidin, Amoquin

Injectables, such as, Larither, Paluther, Quinine

Granules or powders, such as Artequin, Paediatric
If the outlet has no antimalarials in stock cross-check screening results then proceed to question A16.
Proceed to the antimalarial audit. Different antimalarial audit sheets will be used to record the antimalarial information
based on the dosage form of the medicine.
Separate the antimalarials into two piles:
 The first pile should contain all the antimalarials in the form of tablets, suppositories, or granules.
Use the Tablets, Suppositories & Granules Drug Audit Sheet to record these.

The second pile should contain all the antimalarials in any form other than tablets, suppositories or granules. Use the
Non-Tablet Drug Audit Sheet to record these.
If additional audit sheets are used, add these sheets after the ones provided and staple the questionnaire again.
All pages should be in order before you move onto the next outlet.
Number each drug by assigning a Product Number (starting from 1 for TSG drugs and again from 1 for NT drugs).
Number each audit sheet used in the spaces provided at the bottom of the page.
ADDITIONAL NOTES ON THE SUB-OUTLET CODE
In all outlets, complete the Sub-Outlet Code (as well as the Product Number) for each drug audited. These codes are listed
below.
SUB-OUTLET CODES
X
ALL outlets that have only ONE dispensing/distribution point for medicines/diagnostics
A
Outpatient department / dispensary/Main Registered Pharmacy (if used by all patients)
B
Adult outpatient department / adult dispensary / adult clinic
C
Child outpatient department / child dispensary / child clinic
D
Antenatal / maternity clinic/MCH
E
ART / HIV/AIDS clinic/Comprehensive Care Clinic (CCC)
G
Private dispensing unit within a public health facility
L
Laboratory (for RDT audit)
Z
Other (specify the type in the space for audit comments –TSG 15 or NT 15)
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Page 122
TABLET, SUPPOSITORY & GRANULE DRUG AUDIT SHEET (TSG)OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
Sub-outlet
code
1. Generic name
[__|__]
[_____]
_______
Product
number
[__|__]
[__|__]
[__|__|__]
5. Manufacturer
12. Retail selling price
2. Strength
[__|__|__].[__]mg
[__]
[__|__|__].[__]mg
[__]
[__|__|__].[__]mg
1 = Yes
0 = No
8 = Don’t know
[__]
If no, specify salt:
3. Dosage
form/formulation
4. Brand name
(Include weight and age information)
1 = Tablet
2 = Suppository
3 = Granule
[___]
[________________________]
7. Package size
8. Is product 9. Does
10. Amount sold/distributed in the last 7 days to individual
a fixed-dose product
consumers (Record # of packages / tins described in Q7 OR record
There are a total of
combination have the
the total # of tablets / suppositories / granule packs sold)
(FDC)
AMFm
[___|___|___|___]
logo?
This outlet sold [___|___|___] packages/ tins in the last 7 days
tablets/ suppositories/ 1 = Yes
granule sachets in
1 = Yes
OR
0 = No
each:
0 = No
8 = Don’t
This outlet sold [___|___|___] tablets/ suppositories or granule
8 = Don’t
know
1 = Package
sachets in the last 7 days
know
2 = Pot/tin
Not applicable = 995; Refused = 997; Don’t know = 998
[___]
[___]
[__|__|__]
[___]
13. Wholesale purchase price
14. Why do you stock this medicine [SHOW PRODUCT]? 15. Comments
Do not read list.
For the outlet’s most recent wholesale purchase
Circle ALL responses given
[__|__]
6. Country of
manufacture
[___|___|___]
tablets, suppositories or granule
sachets cost an individual customer [___|___|___|___]
tablets, suppositories or granule sachets cost
[___|___|___|___] KSH
[___|___|___|___|___] KSH
Free = 0000
Refused = 9997
Don’t know = 9998
2a. Is this base strength?
Free = 00000
Refused = 99997
Don’t know = 99998
11. Stocked out
at any point in
the past 3
months?
1 = Yes
0 = No
8 = Don’t
know
[___]
Free supply
A
Profitable
B
Recommended by the government C
Low price
D
Customer demand or preference
E
Positive brand reputation
F
Often prescribed by doctors
G
Most effective for treating malaria
H
Don’t know
X
Other
Z
specify [_________________________________]
Tablet Audit Sheet [__|__] of [__|__]
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Page 123
NON-TABLET DRUG AUDIT SHEET (NT): SYRUP, SUSPENSION, INJECTIONS & OTHERS
Sub-outlet
code
1. Generic name
2. Strength
[__|__]
[_____]
_______
Product
number
2a. Is this base strength?
[__|__|__|__].[__]mg/[__|__|__] .[__]mL
[__|__]
[__|__|__|__].[__]mg/[__|__|__] .[__]mL
[__|__]
[__|__|__|__].[__]mg/[__|__|__] .[__]mL
(Note: no mL recorded for powder
injection)
[__|__|__]
4. Brand name
(Include weight and age
information)
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
[__|__]
5. Manufacturer
6. Country of
manufacture
7. Package size
There are a total of
[__]
[__]
[__]
If no, specify salt:
12. Retail selling price
[___|___|___]
bottles ampoules or vials cost an
individual customer
13. Wholesale purchase price
For the outlet’s most recent wholesale
purchase:
[___|___|___|___]
bottles, ampoules or vials cost
[___|___|___|___] KSH
[___|___|___|___|___] KSH
Free = 0000
Refused = 9997
Don’t know = 9998
Free = 00000
Refused = 99997
Don’t know = 99998
1 = Syrup
2 = Suspension
3=Liquid injection
4 =Powder injection
5 = Drops
6 = Other (specify) [___________]
[______________________]
9. Does this
10. Amount sold/ distributed in
product have
the last 7 days to individual
the AMFm logo? consumers
[___|___|___|___].[__] mL 1 = Yes
(or mg for powder
0 = No
injections) in each:
8 = Don’t
1 = Bottle
know
2 = Ampoule/vial
[__|__|__]
1 = Yes
0 = No
8 = Don’t know
3. Dosage form/formulation
This outlet sold
[___|___|___|___] bottles,
ampoules or vials in the
last 7 days
[___]
11. Stocked out at
any point in the
past 3 months?
1 = Yes
0 = No
8 = Don’t
know
[___]
Refused = 9997;
Don’t know = 9998
14. Why do you stock this medicine [SHOW PRODUCT]? 15. Comments
Do not read list.
[___]
[___]
Free supply
A
Profitable
B
Recommended by the government C
Low price
D
E
F
Often prescribed by doctors
G
Most effective for treating malaria
H
Don’t know
X
Other
Z
specify [_________________________________]
Non-Tablet Audit Sheet [___|___] of [___|___]
www.ACTwatch.info
Page 124
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
Antimalarials recently in stock
A16. Are there any antimalarial medicines that are out of stock today, but that you stocked in the
past 3 months?
1 = Yes
0 = No
8 = Don’t know
go to A17
go to Section 4: Diagnostic Audit
go to Section 4: Diagnostic Audit
[___]
A17. What are the names of the treatments that are out of stock?
Will accept generic or brand names. Record one medicine per line.
1 = Yes, specify
[_______________________________________]
[_______________________________________]
[_______________________________________]
[_______________________________________]
[_______________________________________]
[_______________________________________]
[_______________________________________]
[_______________________________________]
[_______________________________________]
[_______________________________________]
[___]
0 = No, provider can’t remember
Interviewer: Go to Section 4: Diagnostic Audit
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Page 125
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
Section 4: Diagnostic Audit
This section is about availability of malaria blood testing. Completing the questions may require speaking with more
than 1 staff member at the outlet. If the respondent does not know the answer to a question in this section, ask to
speak with another staff member who can provide the information.
D1. Does this outlet/facility have disposable gloves available today for staff to use when seeing
customers/patients?
1 = Yes
0 = No
8 = Don’t know
D2. Does this outlet/facility have a sharps container, also called a sharps disposal box or safety box,
available today for staff to use?
[___]
1 = Yes
0 = No
8 = Don’t know
D2a. How does this facility dispose used sharps such as needles?
Do not read list. Circle ALL responses given
[___]
Pay another facility to incinerate
Incinerate within the facility
Bury
Other(specify)[___________________________________]
D3. Is malaria microscopic testing available here today?
1 = Yes
0 = No
A
B
C
D
[___]
go to D7
D4. How many people were tested for malaria at this facility/outlet using microscopy within the past 7
days?
997 = Refused
998 = Don’t know
[___|___|___]
D5.
What is the total cost for a microscopic test for malaria for an adult: [___|___|___|___] KSH
Free = 0000; NA =9995; Refused = 9997; Don’t know=9998
D6.
What is the total cost for a microscopic test for malaria for a child under five: [___|___|___|___] KSH
Free = 0000; NA = 9995; Refused = 9997; Don’t know=9998
D7. Malaria rapid diagnostic tests, also called RDTs, are small, individually wrapped blood tests that are
able to quickly diagnose whether a person has malaria. Show RDT images in prompt card
Are malaria RDTs available here today?
1 = Yes
0 = No
Don’t know
[___]
go to D9
ask to speak with a respondent who has this information
D8. Please show us the full range of RDTs that you currently have in stock. Do you currently have any of the following?
Read entire list; No response to be recorded.



SD Bioline, SD Malaria Antigen, U-Test Malaria
Wondfo One Step, Nova Test
First Response, ParaCheck, CareStart
Proceed to the RDT audit.
If additional audit sheets are used, add these sheets after the ones provided and staple the questionnaire again. All pages
should be in order before you move onto the next outlet.
Number each RDT by assigning a Product Number.
Number each audit sheet used in the spaces provided at the bottom of the page.
Complete the Sub-outlet Code as well as the Product Number for each RDT audited.
Sub-outlet codes are listed on page 3.
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RAPID DIAGNOSTIC TEST AUDIT SHEET (RDT) OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
Sub-outlet
code
1. Brand name
2. Antigen test
(circle ALL that apply)
[_____]
Product
number
Not indicated
Z
HRP2
A
3. Parasite species
(circle ALL that apply)
Not indicated
Z
Pf
A
Pv
B
Po
C
pm
D
pan
E
vom/Pvom
F
Other
G
pLDH B
Aldolase C
[__|__|__]
4. Manufacturer
5. Country of
Manufacture
6. Lot Number
Refused = 9997;
Don’t know=9998
[___]
8. What is the name of your supply
company for this product? Record name.
9. When did you first receive or
place an order for this product?
Record month and year.
[_________________________________]
[___|___| - |__2_|_0_|___|___]
Month - Year
14a. Do you or other staff use this brand
of RDT to test clients here at this
facility/outlet?
1 = Yes
0 = No go to 15a
8 = Don’t know go to 15a
15a. Does this facility/outlet provide
this brand of RDT for clients to take
away for testing somewhere else?
1 = Yes
0 = No go to 16
8 = Don’t know go to 16
10. What was the date of your most recent
order for this product? Record month and year.
[___|___| - |_2_|_0_|___|___]
Month - Year
16. Wholesale purchase
price
For the outlet’s most
recent wholesale
purchase:
[___|___|___|___] tests
[___]
[___]
14b. If yes, what is the total cost for an
adult to have a test conducted with this
RDT, including RDT cost and service fee?
15b. If yes, what is cost of this RDT
for an adult?
[___|___|___|___] KSH
[___|___|___|___] KSH
14c. If yes, what is the total cost for a child
under the age of five to have a test
conducted with this RDT, including RDT
cost and service fee?
1 = Yes
0 = No
8 = Don’t
know
Not indicated = 998
Specify [_____________________]
7. Does the product have a
checkmark logo? Show prompt
card.
1=Yes
0=No
go to 12
8=Don’t know go to 12
[___]
12. Number of tests 13. Has
sold/ distributed
this test
/used in the last 7
been
days to individual
stocked
consumers
out at any
(Record total # of
point in
tests)
the past 3
This outlet sold or
months?
distributed
1 = Yes
0 = No
[___|___|___|___]
8 = Don’t
tests in the last 7
know
days
7a. Is this a
self test kit,
with each
test kit copackaged
with its own
buffer,
pipette and
lancet?
15c. If yes, what is the cost of this
RDT for a child under the age of five?
[___|___|___|___] KSH
[___|___|___|___] KSH
cost
[___|___|___|___|___]
KSH
Free = 00000
NA = 99995
Refused = 99997
Don’t know=99998
[___]
11. How many RDT cassettes
did you purchase/receive for
your most recent order ?
[___|___|___|___]
Refused = 9997 ; Don’t know =
9998
17. Why do you stock this RDT [SHOW RDT]?
Do not read list
Free supply
A
Profitable
B
Recommended by the government
C
Low price
D
E
F
Don’t know
X
Other
Z
specify
[_______________________________]
Free = 0000; NA = 9995; Refused = 9997; Don’t know=9998
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Page 127
18.
Com
ment
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
RDT stock outs
D9. Are there any malaria RDTs that are out of stock today, but that you stocked in the past 3 months?
1 = Yes
0 = No
8 = Don’t know
[___]
go to D11
go to D11
D10. What are the brand names of the malaria RDTs that are out of stock?
Record one brand per line.
1 = Yes, specify
[____________________________________________________________________________]
[___]
[____________________________________________________________________________]
[____________________________________________________________________________]
0 = No
D11. Does this facility/outlet provide medicines or prescription for medicines?
1 = Yes
0 = No
go to Section 5: Provider Module
Confirm response in S3 or S4 is not equal to 1 and outlet type recorded in C7
is 18 or 19 (“lab only”).
Go to Section 7: ORS and ZINC and then Go to Section 6: Audit Tracking Sheet.
www.ACTwatch.info
[___]
Page 128
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
Section 5: Provider Module
This section is for the senior-most staff member who is responsible for providing treatment, prescriptions or
medicines to clients/patients.
P1. Do your responsibilities at this outlet/facility include: providing prescriptions, treatment, or
medicines to clients?
|___]
1 = Yes
No ask to speak with the senior-most person at the outlet with 1 or more of these
responsibilities.
P2. For how many years have you worked in this outlet/facility? If less than 1 year, enter 01
[___|___]
P3. What age are you today? Write age in years
97 = Refused
98 = Don’t know
[___|___]
P4. Don’t read: Is respondent male or female?
[___|___]
1 = Male
2 = Female
P5. What is the highest level of education you completed?
1
2
3
4
5
6
7
=
=
=
=
=
=
=
No formal education
Some primary school
Completed primary school
Some secondary school
Completed secondary school
Some university/college
Completed a university/college degree
[___]
P6. Have you received any training in the last 12 months that included a component on malaria
diagnosis, including malaria rapid diagnostic tests or microscopy?
Include pre-service training and stand-alone workshops.
[___]
1 = Yes
0 = No
8 = Don’t know
P7. Have you received any training in the last 12 months on the national treatment guidelines for
malaria? Include pre-service training and stand-alone workshops.
[___]
1 = Yes
0 = No
8 = Don’t know
P8. Do you have any of the following health qualifications?
Read list. Record 1 for yes, 0 for no
I.
IV.
Pharmacist
[___]
II.
Medical doctor
[___]
III.
Clinical Officer
[___]
Nurse / Nursing Officer
[___]
Midwife
[___]
Laboratory technician / Lab assistant
V.
[___]
VII.
Pharmaceutical technologist
[___]
VIII.
Registered Pharmacy technician
[___]
IX.
Public Health Technician/Officer
[___]
Medical assistant / Nursing Assistant / Nursing Aid
[___]
Community based distributor/Community Health Worker
[___]
Other 1: specify [______________________________]
[___]
VI.
X.
XI.
XII.
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Page 129
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
P9. Not including yourself, do any other people working in this outlet or facility have the following health
qualifications? Read list.
Record 1 for yes, 0 for no, 8 for don’t know
I.
IV.
Pharmacist
[___]
II.
Medical doctor
[___]
III.
Clinical Officer
[___]
Nurse / Nursing Officer
[___]
V.
Midwife
[___]
Laboratory technician / Lab assistant
[___]
VII.
Pharmaceutical technologist
[___]
VIII.
Registered Pharmacy technician
[___]
IX.
Public Health Technician/Officer
[___]
Medical assistant / Nursing Assistant / Nursing Aid
[___]
Community based distributor/Community Health Worker
[___]
XII.
Other 1: specify [______________________________]
[___]
XIII.
Other 2: specify [______________________________]
[___]
XIV.
Other 3: specify [______________________________]
[___]
VI.
X.
XI.
Interviewer: For the following questions record the antimalarial brand name or generic name, and dosage form, in the spaces
provided.
Ask the provider to show you the medicine if it is in stock to verify the name and dosage form.
P10. In your opinion, for treating uncomplicated malaria in adults, what is the most effective antimalarial medicine?
Ask the provider to show you the medicine if it is in stock.
Generic or brand name
Dosage form/formulation
01 = Tablet
04 = Syrup
07 = Drops
02 = Suppository 05 = Suspension
95 = None specified
03 = Granule
06 = IM/IV Injection
98 = Don’t know
(liquid or powder)
[______________________________________]
[___|___]
Don’t know = 98
P11. In your opinion, for treating uncomplicated malaria in children under five, what is the most effective antimalarial
medicine?
01 = Tablet
04 = Syrup
07 = Drops
95 = None specified
03 = Granule
98 = Don’t know
(liquid or powder)
[_______________________________________]
Don’t know = 98
[___|___]
www.ACTwatch.info
Page 130
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
P12. What antimalarial medicine for treating uncomplicated malaria in adults do you most often recommend to customers?
01 = Tablet
04 = Syrup
07 = Drops
95 = None specified
03 = Granule
98 = Don’t know
(liquid or powder)
[______________________________________]
[___|___]
Don’t know = 98
P13. What antimalarial medicine for treating uncomplicated malaria in children under five do you most often recommend to
customers?
01 = Tablet
04 = Syrup
07 = Drops
95 = None specified
03 = Granule
98 = Don’t know
(liquid or powder)
[______________________________________]
[___|___]
Don’t know = 98
P14. In your opinion, for treating severe malaria in children under five, what is the most effective antimalarial medicine?
01 = Tablet
04 = Syrup
07 = Drops
95 = None specified
03 = Granule
98 = Don’t know
(liquid or powder)
[_____________________________________]
[___|___]
Don’t know = 98
P15. What antimalarial medicine for treating severe malaria in children under five do you most often recommend to
customers?
01 = Tablet
04 = Syrup
07 = Drops
95 = None specified
03 = Granule
98 = Don’t know
(liquid or powder)
[_____________________________________]
[___|___]
Don’t know = 98
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Page 131
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
P16. Please name the first line medicine recommended by the government to treat uncomplicated
malaria.
Do not read list. Only one response allowed.
01 = Artemether Lumefantrine (Lonart, Artefan, Lumartem, Coartem) …………………………… Go to P17
02 = ACT................................................................................................................................ Go to P17
03 = ACTm............................................................................................................................. Go to P17
04 = Artesunate Amodiaquine (DUAC, Coarsucam, Winthrop)
05 = Dihydroartemisinin Piperaquine (Duo-cotecxin, P-alaxin)
06 = Amodiaquine
07 = Artemether
08 = Artemisinin
09 = Artesunate
Go to P19
10 = Chloroquine
11 = Quinine
12 = Sulfadoxine Pyrimethamine (Fansidar, SP, Orodar, Ekelfin, Metakelfin)
96 = Other specify: [______________________________________________]
98 = Don’t know
[___|___]
P17. Please explain the government recommended treatment regimen for this drug for an adult (60kg)
Read the following 3 questions to the provider
I. How many tablets should they take at a time? [___|___].[___|___]
II. How many times per day?
[___|___]
III. Over how many days?
[___|___]
Non-tablet = 94
NA = 95
Don’t know = 98
If respondent has the medicine available use the package to complete the table below.
If the medicine is not available ask respondent to identify from prompt card.
If identification not possible, ask respondent to recall medicine details.
Generic name
Strength in mg
Brand name
[__|__]
_______________________________
[__|__|__].[__]mg
[__|__]
_______________________________
[__|__|__].[__]mg
[__|__]
_______________________________
[__|__|__].[__]mg
[___|___]
Manufacturer
Don’t know=999.8
Is this drug a fixed-dose combination
1 = Yes
0 = No
8 = Don’t know
[___]
Don’t know = 98
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Page 132
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
P18. Please explain the government recommended treatment regimen for this drug for a 2-year old child (10kg) Read the
following 3 questions to the provider
I. How many tablets should they take at a time? [___|___].[___|___]
II. How many times per day?
[___|___]
III. Over how many days?
[___|___]
Non-tablet = 94
NA = 95
Don’t know = 98
If respondent has the medicine available use the package to complete the table below.
If the medicine is not available ask respondent to identify from prompt card.
If identification not possible, ask respondent to recall medicine details.
Generic name
Strength in mg
Brand name
[__|__]
_______________________________
[__|__|__].[__]mg
[__|__]
_______________________________
[__|__|__].[__]mg
[__|__]
_______________________________
[__|__|__].[__]mg
[___|___]
Manufacturer
Don’t know=999.8
Is this drug a fixed-dose combination
1 = Yes
0 = No
8 = Don’t know
[___]
Don’t know = 98
P19. Please name the medicine recommended by the government to treat severe malaria.
01 = Artesunate (Artesun, Larinate) ……………………………………………………………………………. Go to P20
02 = Artemether (Artenam, Paluther., Artesiane, Larither) ...................... Go to P20
03 = Quinine...................................................................................................................... Go to P20
04 = ACT/ACTm
05= Artemether Lumefantrine (Lonart, Artefan, Lumartem, Coartem)
06 = Artesunate Amodiaquine (DUAC, Coarsucam, Winthrop)
07 = Dihydroartemisinin Piperaquine (Duo-cotecxin, P-alaxin)
Go to P21
08 = Chloroquine
09 = Sulfadoxine Pyrimethamine (Fansidar, SP, Orodar, Ekelfin, Metakelfin)
96 = Other (specify): [ _________________________________________]
98 = Don’t know
P20. What is the dosage form/formulation medicine recommended by the government to treat severe
malaria? Do not read dosage form options
01 = Tablet
02 = Suppository
03 = Granule
04 = Syrup
05 = Suspension
06 = IM/IV Injection (Liquid or powder)
07 = Drops
95 = None specified
98 = Don’t know
www.ACTwatch.info
[___|___]
[___|___]
Page 133
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
P21. Malaria rapid diagnostic tests, also called RDTs, are small, individually wrapped blood tests that are able to
quickly diagnose whether a person has malaria. Show RDT images in prompt card
Have you ever seen or heard of malaria RDTs?
1 = Yes
0 = No
8 = Don’t know
[___]
Go to P22
Go to P29
Go to P29
P22. Have you ever tested a client for malaria using an RDT?
1 = Yes
0 = No
8 = Don’t know
[___]
P23. Would you ever recommend a patient/customer take an antimalarial if a blood test using a rapid
diagnostic test produced a negative test result for malaria?
Read list. Record only one response.
1 = Yes, Sometimes
2 = Yes, Always
3 = No, Never
8 = Don’t know
[___]
go to P25
go to P25
P24. Under what circumstances would you recommend a patient/customer take an antimalarial following a
negative RDT test for malaria?
Do not read list. Prompt “anything else” until the respondent is finished.
When they have signs/symptoms of malaria
When they ask for antimalarial treatment
When they are a child
When they are an adult
When they are a pregnant woman
When I do not trust/believe the test
When I know the patient/customer
Other (specify) [_______________________________________________]
A
B
C
D
E
F
G
X
P25. Have you ever seen or heard about the RDT with a checkmark logo before?
Show the RDT with the checkmark logo
1= Yes
0= No
go to P29
98= Don’t know
go to P29
P26. Where did you see or hear about the RDT with a checkmark logo?
Do not read list. Circle ALL that apply
[___]
I attended a training
A
My colleague in this outlet attended a training
B
Brochure/booklet/job aid
C
Billboard
D
Poster
E
Distributor/supplier
F
From the RDT product
G
Radio
H
Colleague
I
Nearby facility
J
K
Other (specify): [___________________________________________]
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Page 134
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
P27. Do you have any posters, brochures, or other job aids available here that describe malaria
testing with an RDT?
1=Yes
0=No
8=Don’t know
[___]
go to P29
go to P29
P28. Ask to see the materials. Does the RDT with the checkmark logo appear on any of the
materials?
[___]
1=Yes
0=No
8=Don’t know
P29. What are the danger signs of severe illness in a child under 5?
Do not read list. Prompt “anything else” until the respondent is finished.
A
Unable to drink /unable to breastfeed
B
Vomits everything
C
Convulsions
D
Lethargic or unconscious
Z
Don’t know
Other (specify) [__________________________________________________________]
X
P30. What would you do if a 2-year old child was brought to this outlet with the danger signs of severe
illness?
01 = Seek advice/help from someone in this facility
02 = Treat the child in this facility
03 = Refer to a health facility (clinic, hospital) with or without treating here
[___|___]
04 = Refer to a non health facility outlet (not a clinic or hospital) with or without treating here
05 = Send them away/home without medicine
06 = Send them away/home with medicine
96 = Other – specify: [__________________________________________________________]
98 = Don’t know
Complete the audit sheet tracker on the next page then follow the instructions for ending the interview.
www.ACTwatch.info
Page 135
OUTLET ID: [___|___]-[___|___]-[___|___|___]-[___|___|___|___]-[___|___|___]
Section 6: Audit Tracking Sheet
T1. Were there any antimalarial TABLETS/SUPPOSITORIES/GRANULES in stock at this outlet?
1 = Yes
0 = No
go to T4
8 = Don’t know go to T4
[___]
T2. Total number of TABLET/SUPPOSITORY/GRANULE audit sheets completed
[___|___]
T3. Did you complete audit sheet information for all available TABLETS/SUPPOSITORIES/GRANULES?
1 = Yes, audit complete
0 = No, audit not complete
[___]
T4. Were there any antimalarial NON TABLETS (Syrups, suspensions, Injectables) in stock at this
outlet?
1 = Yes
0 = No
go to T7
[___]
T5. Total number of NON-TABLET audit sheets completed
[___|___]
T6. Did you complete audit sheet information for all available NON-TABLETS?
[___]
T7. Were there any RDTs in stock at this outlet?
1 = Yes
0 = No
go to T10
[___]
T8. Total number of RDT audit sheets completed
[___|___]
T9. Did you complete audit sheet information for all available RDT?
[___]
T10. COMMENTS: Reason for incomplete audit sheets (if response is no to T3, T6, or T9):
THANK THE PROVIDER FOR THEIR PARTICIPATION
Return to C9 and record the final status of the interview and time completed. Then complete Section 7: ORS
and Zinc and Section X: Ending the Interview.
www.ACTwatch.info
Page 136
Annex 7: Antimalarial Reference
Table X3: Number of antimalarials audited
Urban
Public
Health
Facility
Community
Health
Worker
Privatenotforprofit
ALL
Public /
Not forprofit
Private
forprofit
HF
Registered
Pharmacy
Unregistered
Pharmacy
General
retailer
Total
Private
ALL
Outlets
622
3
102
727
1124
3401
2181
110
6816
7543
Census
215
3
102
320
1124
1530
2181
110
4945
5265
Booster
407
0
0
407
0
1871
0
0
1871
2278
Rural
1108
31
61
1200
237
294
410
215
1156
2356
Census
251
31
61
343
237
129
410
215
991
1334
Booster
857
0
0
857
0
165
0
0
165
1022
1730
34
163
1927
1361
3695
2591
325
7972
9899
TOTAL
Table X4: Quality-Assured (QA ACT) and Non-Quality Assured ACTs
Quality-Assured ACT (QA ACT)
QA ACTs are ACTs that comply with the Global Fund to Fight AIDS, Tuberculosis and Malaria’s Quality Assurance Policy. A QA ACT is any ACT
that appeared on the Global Fund's indicative list of antimalarials meeting the Global Fund's quality assurance policy * prior to data collection,
or that previously had C-status in an earlier Global Fund quality assurance policy and was used in a program supplying subsidized ACTs. QA
ACTs also include ACTs that have been granted regulatory approval by the European Medicines Agency (EMA)** – specifically Eurartesim®
and Pyramax®.
Artesunate Amodiaquine Tablets
Winthrop Infant 2-11 months #
Winthrop Toddler 1-5 years #
Winthrop Child 6-13 years #
Winthrop Adult +14 years #
Artesun- Plus 2-11 months #
Artesun- Plus 1-5 years #
Artesun- Plus >14 years #
Artemether Lumefantrine Tablets
Artefan 20/120 5-14kg Dispersible ^#
Artefan 20/120 25-34kg ^#
Artefan 20/120 35+ Kg Adults ^#
Artemether + Lumefantrine <3years (IPCA Laboratories LTD) ^#
Artemether + Lumefantrine 3-8years (IPCA Laboratories LTD) ^#
Artemether + Lumefantrine >14 years (IPCA Laboratories LTD) ^#
Co-Falcinum 5-14 Kg ^
Co-Falcinum 15-24 Kg ^#
Co-Falcinum 25-34 Kg #
Co-Falcinum 35Kg and above ^#
Coartem Dispersible 5-14kg ^#
Coartem 20/120 25-35 Kg ^#
Coartem 20/120 35 Kg+ ^#
Combiart 20/120 ^#
Combiart 20/120 5-15 Kg#
Lumartem 15 To <25kg (Cipla Pharma LTD) #
Lumartem 35kg and above (Cipla Pharma LTD) ^#
Lumerax 20/120 #
Lumet #
Non-Quality-Assured ACT
ACTs that do not meet the definition of being quality-assured.
Altem #
Artefan 40/240 #
Dihydroartemisinin Piperaquine Tablets
Co-malasinin 40/320 #
D-artepp 40mg/320mg #
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Table X4: Quality-Assured (QA ACT) and Non-Quality Assured ACTs
Artefan 80/480 #
Coartem 80/480 35 kg + #
Co-corither DS 35kg + #
Cofantrine Forte #
Co-max #
Lamitar AM ^
Lonart Tablets #
Lonart DS ^#
Lonart Forte #
Lum-artem 20/120 (Dawa Limited) #
Lumesoft plus #
Luteriam #
Lumether #
Artesunate Sulfadoxine Pyrimethamine Tablets
Co-arinate FDC Adult ^#
Co-arinate FDC Junior #
Darte-q #
Duo-cotexcin Children 5-20kg #
Duo-cotecxin 40/320 ^#
Duotab ^#
Malacur 40/320 #
P-Alaxin 40/320 ^#
Ridmal 40/320 #
Artemether Lumefantrine Suspension
Artefan Suspension ^#
Co-Artesiane Pediatric ^#
Co-corither Pediatric #
Co-max #
Lonart 20/120 Pediatric ^#
Lum-artem Children 1-5 Years (Dawa Limited) #
Lumether #
Artemisinin Naphthoquine Tablets
Arco ^#
Dihydroartemisinin Piperaquin Suspension
Malacur for Infants and Children ^#
P-Alaxin Pediatric Suspension ^#
Artemisinin Piperaquine Tablets
Artequick ^#
Artemether Lumefantrine Suppository
Lonart #
Arenax #
Dihydroartemisinin Piperaquin Granules
Darte-q paediatric #
Artesunate Mefloquine Tablets
Artequin 300/375 child #
Artequin 600/750 adult ^#
Artesunate Mefloquine Granules
Artequin paediatric #
* http://www.theglobalfund.org/en/procurement/quality/pharmaceutical
**http://www.ema.europa.eu/
^
Product audited in the public sector
#
Product audited in the private sector
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Table X5: Nationally Registered ACTs
ACT registered with Kenya’s national drug regulatory authority and permitted for sale or distribution in Kenya.
Winthrop Adult +14 Years #
Winthrop Child 6-13 Years #
Winthrop Infant 2-11 Months #
Coartem 20/120 25-35 Kg ^#
Winthrop Toddler 1-5 Years #
Coartem 20/120 35 Kg+ ^#
Co-falcinum 5-14kg ^#
Artesunate Sulfadoxine Pyrimethamine Tablets
Co-falcinum 15-24kg ^#
Co-arinate FDC Adult ^#
Co-falcinum 25-34kg #
Co-arinate FDC Junior #
Co-falcinum 35kg And Adults ^#
Co-max #
Artemisinin Piperaquine Tablets
Lonart #
Artequick ^#
Lonart Ds ^#
Lonart Forte #
Dihydroartemisinin Piperaquine Tablets
Lum-Artem 20/120 (Dawa Limited) #
D-Artepp 40mg/320mg #
Lumartem 15 To <25kg (Cipla Pharma LTD) #
Malacur 40/320 #
Lumartem 35kg And Above (Cipla Pharma LTD) ^#
P-Alaxin 40/320 ^#
Lumerax 20/120 ^#
Ridmal 40/320 #
Artemether Lumefantrine Suspensions
Artesunate Mefloquine Tablets
Artefan Suspension ^#
Artequin 300/375 Child #
Lonart Paediatric ^#
Artequin 600/750 Adult ^#
Lum-artem Children 1-5 Years (Dawa Limited) #
Dihydroartemisinin Piperaquine Suspensions
Altem #
P-Alaxin Pediatric Suspension ^#
Artefan 20/120 25-34kg ^#
Artefan 20/120 35+ Kg Adults ^#
Artefan 40/240 #
Artefan 80/480 #
Artemether + Lumefantrine <3years (IPCA Laboratories LTD) ^#
Artemether + Lumefantrine >14 years (IPCA Laboratories LTD) ^#
^
#
Product audited in the public sector
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Table X6: Severe Malaria Treatment
WHO recommends parenteral artesunate as first-line treatment in the management of severe falciparum malaria,
with artemether or quinine injections as acceptable alternatives if parenteral artesunate is not available*. If
complete treatment for severe malaria is not possible, patients with severe malaria should be given pre-referral
treatment and referred immediately to an appropriate facility for further treatment. The following are options for
pre-referral treatment: rectal artesunate, injectable quinine, injectable artesunate, injectable artemether, and
injectable arteether/artemotil.
Quinine Liquid Injection (Manufacturer)
Agenquine Injection (Shandong Xier Kangali Pharmaceutical
Co. Ltd) ^#
Kwinil (Intas Pharmaceuticals Ltd) #
Artemether Liquid Injection (Manufacturer)
Laquine Injection (Cosme Limited) ^#
Artesiane 100 (Dafra Pharma Gmbh) ^#
Megaquin Injection (Royal Group) #
Artesiane 80 (Dafra Pharma Gmbh) ^#
Mosqun Injection (Indus Pharma (Pvt) Ltd) ^#
Artesiane 40 (Dafra Pharma Gmbh) #
Quinine Dihydrochloride (Laborate Pharmaceutical) ^#
Corither AB (Coral Laboratories Ltd) #
Falcinum 40 (Cipla Ltd) #
Quimed Injection (Syner-Med Pharmaceutical Ltd) ^#
Quinine Dihydrochloride (Rotexmedica Gmbh
Arzneimittelwerk) ^#
Quinine Dihydrochloride (Intas Pharmaceutical Ltd) #
Artenam 100 (Arenco Pharmaceutical) ^#
Artenam 40 Paediatric (Arenco Pharmaceutical) #
Falcinum 80 (Cipla Ltd) #
Quinine Dihydrochloride (Gland Pharma Ltd) ^#
Glinther (Guilin Pharmaceutical Co Ltd) #
Gvither 20 Injection (Bliss Gvs Pharma Ltd) ^#
Quinine Dihydrochloride (Systochem Laboratories Ltd) #
Gvither 40 Injection (Bliss Gvs Pharma Ltd) ^#
S-Quin Injection (Swiss Parenteral Pvt Ltd) ^#
Gvither Forte Injection (Bliss Gvs Pharma Ltd) ^#
Arteether/Artemotil Liquid Injection (Manufacturer)
Indomal Injection (Indus Pharma (Pvt) Ltd) #
Larither 40 (IPCA Laboratories Ltd) ^#
Artimal (Indi Pharma Pvt Ltd) #
Larither 80 (IPCA Laboratories Ltd) ^#
Emal Injection (Themis Medicare Ltd) #
Malgo 80mg (Ccl Pharmacetical (Pvt) Ltd)#
Malither Injection (Themis Medicare Ltd) #
Artesunate Powder Injection (Manufacturer)
Syn-Mal 80mg (Swiss Parenteral Pvt Ltd) #
Artesun 120mg (Guilin Pharmaceutical Co Ltd) ^#
Tether 80mg (Luckon Pharmaceuticals) #
Artesun 30mg (Guilin Pharmaceutical Co Ltd) #
Artesun 60mg (Guilin Pharmaceutical Co Ltd) ^#
Artemether Liquid Injection (Manufacturer)
Artem (Kunming Pharmaceutical Corp) #
Artemal-M Injection (Plethico Pharma Ltd) ^#
Artemedine (Kunming Pharmaceutical Corp) #
Artemether Injection (Jiangsu Ruinian Qianjin Pharmaceutical
Co, Ltd) #
* Guidelines for the treatment of malaria, 2nd edition – revision 1.WHO. Geneva: 2010.
^ Product audited in the public sector
#
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Annex 8: RDT Reference
Table X7: Number of RDTs audited
Urban
Public
Health
Facility
Community
Health Worker
Private Not-forProfit Facility
Private
for-profit
HF
Registered
Pharmacy
Unregistered
Pharmacy
General retailer
ALL
Outlets
113
3
11
111
67
67
0
372
Census
35
3
11
111
21
67
0
248
Booster
78
0
0
0
46
0
0
124
Rural
221
19
8
25
3
6
0
282
Census
49
19
8
25
1
6
0
108
Booster
172
0
0
0
2
0
0
174
334
22
19
136
70
73
0
654
TOTAL
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Table X8: RDT Brand Names and Manufacturers*
Brand Name
Manufacturer
A Con #
A Con Laboratories Inc
Abon ^#
Abon Biopharm (Hangzhou) Co. Ltd
Artron #
Artron Laboratories Inc
Carestart ^#
Access Bio Inc.
Dvg Deangel Biological #
Hang Zhou Deangel Biological Engineering Co Ltd
Ezdx ^#
Advy Chemical
First Response #
Premier Medical Corporation Ltd
Humasis ^#
Humasis Co. Ltd
Ict #
Ict Diagnostics
Immunoquick ^
Biosynex
Makesure #
Hll Lifecare Limited
Malacur #
Blue Cross Bio-Medical (Beijing)Co Ltd
Malaria Self Test #
Ict Diagnostics
Malarigen #
Aspen Laboratories Pvt Ltd
One Step Malaria (P.F.) Test #
Blue Cross Bio-Medical (Beijing)Co Ltd
One Step Malaria (P.F.) Test #
Humasis Co. Ltd
One Step Test ^
Intec Products Inc.
Onsite #
Ctk Biotech Inc.
Paracheck ^#
Orchid Biomedical Systems
Parahit #
Signature Healthcare Ltd
Parascreen #
Zephyr Biomedicals
Sd Bioline ^#
Standard Diagnostics Inc.
Wondfo #
Wondfo Biotech Co Ltd
* 654 RDTs were audited. No RDTs were missing brand name information (missing or don’t know). 8 were missing manufacturer name
(missing or don’t know).
^ Product audited in the public sector
# Product audited in the private sector
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Annex 9. Sampling Weights
Sampling weights were applied for analysis of the Kenya 2014 outlet survey data to account for variations in probability
of selection as a result of the sampling design:
1) Stratification: Disproportionate allocation stratification was used to ensure adequate sample size within the urban
and rural domains to allow for domain-specific estimates. The research domains were based on national
designation of urban and rural wards. A representative sample was selected within each domain.
2) One-stage cluster sampling: Locations were selected from sampling frames within each domain with probability
proportional to size. Within each location, a census of all outlets with the potential to sell or distribute
antimalarials and/or provide malaria blood testing was conducted.
3) Booster sample – public health facilities (PHFs) and pharmacies: The geographic area for the outlet census was
extended to the division level for public health facilities and pharmacies. All public health facilities and pharmacies
within divisions in which the selected locations were located were included in the study.
The sampling weights applied during analysis are the inverse of the probability of selection:
𝑊𝑖 =
1
a ×
Mα
∑ Mα
Where:



Mα =
ΣMα =
a=
estimated cluster (population size)
sum of estimated cluster sizes (population size) in the entire stratum
number of clusters selected within the stratum
Sampling weights are calculated at the cluster level and are applied to all outlets within a given cluster, irrespective
of outlet type.
Market share was calculated using the full census data at the location level only (i.e. the booster sample was not
included in market share calculations). Ward sampling weights were created using the sampling weight formula (Wi),
where:



Mα =
ΣMα =
a=
estimated ward population size
sum of estimated location population size in the entire stratum
number of locations selected within the stratum
The ward sampling weights were applied to all other indicators in the report for all outlet types with the exception of:
1. Public health facilities and pharmacies: Given that PHFs and pharmacies were included in the sample through a
division-wide census, the weights applied to PHFs and pharmacies for all indicators other than market share were
calculated using the sampling weight formula (Wi), where:



Mα = estimated division population size
ΣMα = sum of estimated division population size in the entire stratum
a=
number of divisions selected within the stratum
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The population estimates used to select wards with PPS and to create sampling weights were obtained from the 1999
National Census. A sampling frame with population sizes was used for selecting the sample because accurate estimates
on the total number of outlets per geographic/administrative unit that may be eligible for a medicine outlet survey do
not exist. The major assumption in using population figures for sampling and weighting is that distribution of outlets
and/or distribution of medicines moving through outlets in a given cluster is correlated with population size.
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Annex 10: Indicator Definitions
Table definitions below are reflective of the corresponding table numbers in each results section above
(Table 1 definition corresponds to Table A1, Table B1, Table C1, etc.)
Table 1: Availability of antimalarials, among all screened outlets
Table 1 reports the proportion of all outlets enumerated that had any antimalarial in stock at the time of the survey
visit. Antimalarial availability is reported among all outlets as well as among individual outlet types, all public outlets,
and all private outlets. Availability is reported for any antimalarial as well as specific types of antimalarial medicines.
Numerator
Number of outlets with any antimalarial in stock at the time of the survey visit, as confirmed by
presence of at least one antimalarial (defined as a medicine with antimalarial ingredients)
recorded in the antimalarial audit section.
Denominator
Number of outlets screened.
Calculation
Numerator divided by denominator.
Handling
missing values
All screened outlets will contribute to the denominator. This includes outlets that were eligible
for interview (including antimalarial audit) but: 1) were not interviewed; or 2) the interview was
partially completed.
Notes and
considerations
Given partial or non-completion of interviews among eligible outlets and the inclusion of these
outlets in the denominator, these availability indicators can be considered conservative
estimates of antimalarial availability.
Table 2: Availability of antimalarials, among outlets stocking at least one antimalarial
Table 2 reports the proportion of antimalarial-stocking outlets with specific antimalarial in stock at the time of the
survey visit. Antimalarial availability is reported among all outlets as well as among individual outlet types, all public
outlets, and all private outlets. Availability is reported for any antimalarial as well as specific types of antimalarial
medicines.
Numerator
Number of outlets with any antimalarial in stock at the time of the survey visit, as confirmed by
presence of at least one antimalarial (defined as a medicine with antimalarial ingredients)
Denominator
Number of outlets with at least 1 antimalarial audited.
Calculation
Handling
missing values
All outlets with at least one antimalarial recorded in the antimalarial audit sheet will contribute
to the denominator. This includes outlets where the interview was not fully completed (partial
interview).
Notes and
considerations
Given partial completion of interviews among antimalarial-stocking outlets and the inclusion of
these outlets in the denominator, these availability indicators can be considered conservative
estimates of antimalarial availability.
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Table 3: Antimalarial market composition
Table 3 reports the distribution of outlet types among outlets with at least one antimalarial in stock on the day of the
survey.
Numerator
By outlet type, the number of outlets with any antimalarial in stock at the time of the survey
visit, as confirmed by presence of at least one antimalarial (defined as a medicine with
antimalarial ingredients) recorded in the antimalarial audit section.
Denominator
Total number of outlets with any antimalarial in stock at the time of the survey visit, as confirmed
by presence of at least one antimalarial (defined as a medicine with antimalarial ingredients)
Calculation
Numerator for each outlet type divided by the denominator.
Handling
missing values
All outlets with at least one antimalarial recorded in the antimalarial audit sheet will contribute
to the indicator. This includes outlets where the interview was not fully completed (partial
interview).
Notes and
considerations
Market composition is calculated among outlets located within the representative sample of
clusters, and excludes the booster sample.
Table 4: Price of antimalarials
Table 4a provides the median price of an adult equivalent treatment dose (AETD, see Annex 11) for select tablet
formulation types of antimalarials across outlet types. The inter-quartile range (IQR) is provided as a measure of
dispersion.
Calculation
Median antimalarial AETD (see Annex 11) price in US dollars with inter-quartile range (25th and
75th percentiles).
Handling
missing values
Antimalarials with missing price information are excluded from the median price calculation.
Notes and
considerations
Price in US dollars is calculated based on exchange rates available from www.oanda.com using
the historical exchange rates tool. The average exchange rate over the entire data collection
period is used for converting local currency captured during data collection to US dollars.
A. Table 4b reports the median price of one injection of an antimalarial that should be used for severe malaria
treatment only (artemether injection, quinine injection). The inter-quartile range (IQR) is provided as a measure
of dispersion.
B. Table 4b also provides the median price of two pre-packaged QA ACT therapies: pediatric appropriate for a 10kg
child (2 years of age), and adult appropriate for a 60kg adult. The inter-quartile range (IQR) is provided as a
measure of dispersion.
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Calculation
Median antimalarial injection price in US dollars with inter-quartile range (25th and 75th
percentiles).
Median pre-packaged therapy price in US dollars with inter-quartile range (25th and 75th
percentiles.
Handling
missing values
Antimalarials with missing price information are excluded from the median price calculation.
Notes and
considerations
Table 5: Availability of malaria blood testing among antimalarial-stocking outlets
Table 5 reports the proportion of antimalarial-stocking outlets that had malaria blood testing available. Testing
availability is reported among all outlets as well as among individual outlet types, all public outlets, and all private
outlets. Availability is reported for any blood test as well as specific test types: microscopy and rapid diagnostic test
(RDT).
Numerator
Number of outlets with malaria blood testing available (any, microscopy, RDT).
Denominator
Number of outlets with any antimalarial in stock at the time of the survey visit or reportedly
stocked any antimalarial in the previous three months.
Calculation
Handling
missing values



Notes and
considerations
Antimalarial-stocking outlets with missing information about both availability of microscopy
and availability of RDTs are excluded from this table. The number of such outlets is provided
in a footnote.
Outlets with partial information about availability of blood testing (information about
microcopy or RDTs) are included in the denominator of the indicator “any blood testing
available.” The number of such outlets is provided in a footnote.
Indicators for RDT and microscopy availability exclude outlets with missing availability
information respectively (i.e. outlets missing information about microscopy availability are
excluded from the microscopy indicator).
Survey inclusion criteria extended to outlets providing blood testing but not stocking
antimalarials (“diagnosis/testing-only outlets”). These outlets are excluded from this availability
table.
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Table 6: Malaria blood testing market composition
Table 6 reports the distribution of outlet types among outlets with malaria blood testing available on the day of the
survey.
Numerator
By outlet type, the number of outlets with malaria blood testing available at the time of the
survey visit, as confirmed by presence of at least one RDT recorded in the RDT audit section
and/or reported availability of malaria microscopy services.
Denominator
Total number of outlets with malaria blood testing available at the time of the survey visit, as
confirmed by presence of at least one RDT recorded in the RDT audit section and/or reported
availability of malaria microscopy services.
Calculation
Numerator for each outlet type divided by the denominator.
Handling
missing values
All outlets with non-missing values for the RDT audit or malaria microscopy availability questions
are included in the indicators. This includes outlets where the interview was not fully completed
(partial interview).
Notes and
considerations
Market composition is calculated among outlets located within the representative sample of
clusters, and excludes the booster sample.
Table 7: Price of malaria blood testing
A. Table 7 reports the median price of blood testing to consumers including any consultation or service fees. The
inter-quartile range (IQR) is provided as a measure of dispersion.
Calculation
Median total blood test price in US dollars with inter-quartile range (25th and 75th percentiles).
Handling
missing values
Microscopy-stocking outlets that are missing information about price of microscopy are
excluded from this indicator. Audited RDTs with missing information about price of testing are
excluded from this indicator.
Notes and
considerations
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Table 8: Antimalarial market share
Antimalarial market share is the amount of adult equivalent treatment doses (AETD) reportedly sold or distributed in
the previous week by outlet type and antimalarial type as a percentage of all AETDs sold/distributed in the previous
week. Expressed as a percentage, market share is the amount of a specific antimalarial sold/distributed by a specific
outlet type relative to the entire antimalarial market (all antimalarial types sold/distributed by all outlet types). Totals
are reported per antimalarial medicine type and per outlet type. Across antimalarial medicine types and outlet types,
percentages in the entire table sum to 100% (the total market).
Numerator
Number of AETDs sold/distributed for a specific antimalarial drug category and outlet type.
Denominator
Total number of AETDs sold/distributed.
Calculation
Handling
missing values
AETDs sold/distributed are calculated among audited medicines with complete and consistent
information. Antimalarials with incomplete or inconsistent information among key variables that
define AETD sold/distributed (active ingredients, strength, formulation, package size, amount
sold/distributed) are excluded from the calculation.
Notes and
considerations
See Annex 11 for a description of AETD calculation.
Table 9: Antimalarial market share across outlet type
Antimalarial market share across outlet type is the amount of adult equivalent treatment doses (AETD) reportedly sold
or distributed in the previous week by antimalarial type within each outlet type as a percentage of all AETDs
sold/distributed in the previous week within the specified outlet type. Expressed as a percentage, outlet-type market
share is the amount of a specific antimalarial sold/distributed relative to the entire antimalarial market segment for
the specified outlet type (all antimalarial types sold/distributed by the specific outlet type). Totals are reported per
antimalarial medicine type for each outlet type. Across antimalarial medicine types within each outlet type,
percentages sum to 100%.
Numerator
Number of AETDs sold/distributed for a specific antimalarial drug category within the specified
outlet type.
Denominator
Total number of AETDs sold/distributed within the specific outlet type.
Calculation
Handling
missing values
AETDs sold/distributed are calculated among audited medicines with complete and consistent
information. Antimalarials with incomplete or inconsistent information among key variables
that define AETD sold/distributed (active ingredients, strength, formulation, package size,
amount sold/distributed) are excluded from the calculation.
Notes and
considerations
See Annex 11 for a description of AETD calculation.
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Table 10: Malaria blood testing market share
Malaria blood testing market share is the number of malaria blood tests reportedly sold or distributed in the previous
week by outlet type and malaria blood test type (RDT, microscopy) as a percentage of all malaria blood tests
sold/distributed in the previous week. Expressed as a percentage, market share is the number of a specific malaria
blood test type by a specific outlet type relative to the entire malaria blood testing market (all malaria blood tests
sold/distributed by all outlet types). Totals are reported per test type and per outlet type. Across malaria blood test
types and outlet types, percentages in the entire table sum to 100% (the total market).
Numerator
Number of malaria blood tests sold/distributed for a specific blood test type (RDT, microscopy)
and outlet type.
Denominator
Total number of malaria blood tests sold/distributed.
Calculation
Handling
missing values
Malaria blood tests sold/distributed are calculated among audited RDTs and microscopy services
with complete and consistent information. RDTs and microscopy services with incomplete or
inconsistent information about the amount sold/distributed) are excluded from the calculation.
Notes and
considerations
Records and/or recall of testing with microscopy versus malaria RDT may differ within a given
outlet, introducing an unquantifiable bias in estimating total tests performed.
Table 11: Malaria blood testing market share across outlet type
Malaria blood testing market share across outlet type is the number of malaria blood tests reportedly sold or
distributed in the previous week by blood test type within each outlet type as a percentage of all blood tests
sold/distributed in the previous week within the specified outlet type. Expressed as a percentage, outlet-type market
share is the amount of a specific malaria blood test sold/distributed relative to the entire blood testing market segment
for the specified outlet type (all malaria tests sold/distributed by the specific outlet type). Totals are reported per test
type for each outlet type. Across malaria blood test types within each outlet type, percentages sum to 100%.
The market share for each RDT manufacturer is also reported across outlet type. Within each outlet type, the number
of RDTs for a specific manufacturer sold/distributed relative to all RDTs distributed within that outlet type is reported
as a percentage. Totals for RDT market share across all manufacturers sums to 100% within each outlet type.
Numerator
Number of malaria blood tests sold/distributed for a specific blood test type (RDT,
microscopy), or number of malaria RDTs sold/distributed for a specific manufacturer, within
the specified outlet type.
Denominator
Total number of malaria blood tests/RDTs sold/distributed within the specific outlet type.
Calculation
Handling
missing values
Malaria blood tests sold/distributed are calculated among audited RDTs and microscopy services
with complete and consistent information. RDTs and microscopy services with incomplete or
inconsistent information about the amount sold/distributed) are excluded from the calculation.
Notes and
considerations
Records and/or recall of testing with microscopy versus malaria RDT may differ within a given
outlet, introducing an unquantifiable bias in estimating total tests performed.
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Table 12: Provider case management knowledge and practices
Table 12 reports key indicators of provider case management knowledge and practices. These include referral
practices for severe malaria; and self-reported practices for managing clients who test negative for malaria.
Numerator
A. Referral: respondents who indicated that they would refer to a health facility (response
option #3). Note this numerator excludes providers located in a public or private health
facility.
B. Recommends antimalarials to test-negative clients: respondents who indicated “yes,
always,” or “yes, sometimes.”
C. Circumstances for recommending an antimalarial: individual indicators for the most
common responses provided to this open-ended question. Note this numerator excludes
providers who did not respond to the previous question about recommending
antimalarials to test-negative clients with “yes, always” or “yes, sometimes.”
Denominator
A. Referral: respondents who provided a response to this question, including “don’t know.”
Note this denominator excludes providers located in a public or private health facility.
B. Recommends antimalarials to test-negative clients: respondents who provided a response
to this question, including “don’t know.”
C. Circumstances for recommending an antimalarial: respondents who provided at least 1
response to this question, including “don’t know” (i.e. at least 1 variable in this series is nonmissing). Note this denominator excludes providers who did not respond to the previous
question about recommending antimalarials to test-negative clients with “yes always” or
“yes sometimes.”
Calculation
Handling
missing values
A. Providers missing a response to this question will be excluded from the indicator.
B. Providers missing a response to this question will be excluded from the indicator.
C. This indicator is assessed using an open-ended multiple response option question.
Providers with at least one non-missing response in the variable series for this question will
be included in the indicator. Among these sets of responses, missing will be treated as not
mentioned.
Notes and
considerations
In some cases, multiple providers were interviewed at one outlet. A provider with
responsibilities related to diagnosis may have responded to questions about malaria diagnosis
and diagnostics (indicators B and C in Table 9), while a different provider responsible for
prescribing and/or dispensing medicines may have responded to questions about danger signs
of severe illness and referral for severe malaria (indicator A in Table 8). In all cases, the questions
assessing provider knowledge and practices were administered only one time per outlet. As
such, indicators are tabulated at the outlet level.
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Table 13: Provider antimalarial treatment knowledge and practices
Table 13 reports key indicators of provider antimalarial treatment knowledge and practices. These include knowledge
of the first-line treatment; knowledge of the first-line treatment dosing regimen for adults and children; citing ACT as
most effective to treat malaria in adults and children; and citing ACT as most commonly recommended by the provider
to manage malaria in adults and children.
Numerator
Denominator
Calculation
Handling
missing values
A. State first-line: providers who responded to p17 with a generic or brand name consistent
with a national first-line treatment, or responded to p17 with “ACT,” or “ACTm” and in
p18 provided a generic or brand name consistent with a national first-line treatment. In
other words, providers must specifically name the first-line treatment using generic or
brand name language in either p17 or p18.
B. First-line regimen, adult: providers who correctly stated the first-line generic ingredients
and strengths in p18, and correctly stated: number of days, times per day, and tablets per
dose to be taken.
C. ACT most effective, adult & child: Any response for this open-ended question whereby: 1)
one medicine or a set of medicines to be used in combination is mentioned only i.e.
multiple antimalarial medicines mentioned will be counted as incorrect; and 2) the
combination of medicines is an ACT – defined either by using a brand name, generic
name, “ACT,” or “ACTm.” If the provider mentions a correct ACT response and also
mentioned an anti-pyretic (e.g. paracetamol), this response will be counted as correct.
However, if the provider mentions a correct ACT response and also mentioned other
drugs – such as an antibiotic – this answer will be counted as incorrect.
D. ACT most often recommended, adult & child: Any response for this open-ended question
whereby: 1) one medicine or a set of medicines to be used in combination is mentioned
only i.e. multiple antimalarial medicines mentioned will be counted as incorrect; and 2)
the combination of medicines is an ACT – defined either by using a brand name, generic
name, “ACT,” or “ACTm.” If the provider mentions a correct ACT response and also
mentioned an anti-pyretic (e.g. paracetamol), this response will be counted as correct.
However, if the provider mentions a correct ACT response and also mentioned other
drugs – such as an antibiotic – this answer will be counted as incorrect.
A. State first-line: All providers who responded to p17 – please name the first-line medicine.
B. First-line regimen, adult: All providers who responded to p17 (starting the series on firstline knowledge).
C. ACT most effective, adult & child: All providers who responded to p13/14, including
providers who responded with “don’t know,” who provided names of non-antimalarial
medicines, and who responded with more than one antimalarial medicine not intended to
be used as combination therapy.
D. ACT most often recommended, adult & child: All providers who responded to p13/14,
including providers who responded with “don’t know,” who provided names of nonantimalarial medicines, and who responded with more than one antimalarial medicine not
intended to be used as combination therapy.
A. Providers missing a response to this question will be excluded from this indicator.
B. Providers with partial information for the regimen questions will be included in the
denominator (i.e. missing treated as not mentioned).
C. Providers missing a response to this question will be excluded from the indicator.
D. Providers missing a response to this question will be excluded from the indicator.
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Page 152
Annex 11. Adult Equivalent Treatment Dose (AETD)
Definition
Antimalarial medicines are manufactured using a variety of active pharmaceutical ingredients, dosage forms,
strengths, and package sizes. ACTwatch uses the adult equivalent treatment dose (AETD) as a standard unit for price
and sale/distribution analyses. One AETD is defined as the number of milligrams (mg) of an antimalarial drug required
to treat an adult weighing 60 kilograms (kg). For each antimalarial generic, the AETD is defined as the number of mg
recommended in treatment guidelines for uncomplicated malaria in areas of low drug resistance issued by the WHO.
Where WHO treatment guidelines do not cover a specific generic, the AETD is defined based on peer-reviewed
research or the product manufacturer’s recommended treatment course for a 60kg adult. Table X9 lists AETD
definitions used in this report.
While it is recognized that the use of AETDs may over-simplify and ignore many of the complexities of medicine
consumption and use, this analytical approach was selected because it standardizes medication dosing across drug
types and across countries (which may sometimes vary) thus permitting comparisons on both prices and volumes
calculated on the basis of an AETD.
Additional considerations:

Where combination therapies consist of two or more active antimalarial ingredients packaged together (coformulated or co-blistered), the strength of only one principal ingredient is used. The artemisinin derivative is used
as the principal ingredient for ACT AETD calculations.

Co-blistered combinations are generally assumed to be 1:1 ratio of tablets unless otherwise documented during
fieldwork or through manufacturer websites.

Sulfamethoxpyrazine-pyrimethamine is assumed to have the same full course adult treatment dose as
sulfadoxine-pyrimethamine.
Calculation
Information collected on drug strength and unit size as listed on the product packaging was used to calculate the total
amount of each active ingredient found in the package. The number of AETDs in a unit was calculated.31 The number
of AETDs in a monotherapy is calculated by dividing the total amount of active ingredient contained in the unit by the
AETD (i.e. the total number of mg required to treat a 60kg adult). The number of AETDs for a combination therapy was
calculated by dividing the total amount of the active ingredient that was used as the basis for the AETD by the AETD.
31
The unit is dependent on the drug dosage form. The unit for antimalarials in tablet, suppository, or granule form is the package. The unit for
injectable antimalarials is the ampoule. The unit for syrup and suspension antimalarials is the bottle.
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Page 153
Table X9: Adult Equivalent Treatment Dose Definitions
Antimalarial Generic
[Ingredient used for AETD
mg dose value]
Amodiaquine
Arteether / Artemotil
Artemether
Artemether-Lumefantrine
[Artemether]
Artemisinin-Naphthoquine
[Artemisinin]
Dose used for calculating 1
AETD (mg required to treat a
60kg adult)
Source
1800mg
1050mg
960mg
WHO Model Formulary, 2008
WHO Use of Antimalarials, 2001
480mg
WHO Guidelines for the treatment of malaria 2nd edition, 2010
2400mg
Artesunate
Artesunate-Amodiaquine
[Artesunate]
Artesunate-Mefloquine
[Artesunate]
Artesunate- SulfadoxinePyrimethamine
[Artesunate]
Atovaquone-Proguanil
[Atovaquone]
Chloroquine
960mg
Thanh NX, Trung TN, Phong NC, et al. 2012. The efficacy and tolerability of
artemisinin-piperaquine (Artequick®) versus artesunate-amodiaquine
(Coarsucam™) for the treatment of uncomplicated Plasmodium falciparum
malaria in south-central Vietnam. Malaria Journal, 11:217.
600mg
600mg
600mg
3000mg
1500mg
Dihydroartemisinin
480mg
Manufacturer Guidelines
(Cotecxin – Holleypharm; MALUether – Euromedi)
DihydroartemisininPiperaquine
[Dihydroartemisinin]
360mg
Artemisinin-Piperaquine
[Artemisinin]
Hydroxychloroquine
Mefloquine
Primaquine
Quinine
504mg
2000mg
1000mg
45mg
10408mg
1500mg
Manufacturer Guidelines
(Plaquenil – Sanofi Aventis)
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Page 154
Annex 12: Antimalarial Volumes
Table X10: Antimalarial volumes, by outlet type
AETDs sold or distributed in the
previous week by outlet type
and antimalarial type:*
Public
Health
Facility
# AETD (95% CI)
ALL
Public / Not ForProfit
# AETD (95% CI)
Private
For-Profit
Facility
# AETD (95% CI)
21411.6
28666.5
27435.0
(13047.2, 29776.0)
21261.1
(18967.7, 38365.3)
27600.4
(12897.3, 29624.9)
0.0
130.1
21244.7
Registered
Pharmacy
Unregistered
Pharmacy
General retailer
TOTAL
Private
ALL Outlets
# AETD (95% CI)
# AETD (95% CI)
# AETD (95% CI)
# AETD (95% CI)
# AETD (95% CI)
59694.7
6544.4
(46432.0, 72957.5)
51031.6
(1884.3, 11204.5)
5977.0
(17928.4, 37272.4)
0.0
1024.1
(341.7, 1706.5)
27016.3
(18522.7, 29347.4)
205.6
(3.7, 407.4)
2311.0
(1590.0, 3032.0)
19800.2
(33035.0, 87500.5)
707.8
(73.1, 1342.6)
13669.1
(6867.4, 20470.9)
49868.4
(40267.7, 61795.6)
297.9
(95.9, 499.9)
6353.7
(4043.9, 8663.5)
46666.4
(1564.2, 10389.8)
32.8
440.4
5040.7
(12879.6, 29609.8)
11032.2
(17321.9, 36710.6)
13824.4
(15361.3, 24239.1)
15887.0
(28025.3, 71711.5)
40544.7
(37148.6, 56184.2)
40384.9
(889.6, 9191.9)
3989.8
(5913.8, 16150.7)
10212.5
(5840.2, 14584.7)
166.9
20670.3
(8141.5, 19507.4)
13159.0
(7658.8, 18659.3)
1650.3
(818.8, 2481.8)
27427.1
(12318.9, 19455.2)
3913.1
(2794.9, 5031.4)
7634.8
(5550.7, 9719.0)
24950.6
(24672.0, 56417.5)
9323.7
(3002.8, 15644.5)
28679.8
(13958.9, 43400.7)
62153.6
(32093.7, 48676.1)
6281.5
(3839.3, 8723.7)
13028.4
(8498.5, 17558.3)
52065.7
(0.0, 8054.1)
1050.9
(0.0, 3039.3)
1503.7
5702.4
(12315.6, 29025.0)
5220.5
(2764.1, 7676.8)
4142.2
(2426.5, 5857.8)
514.3
(100.1, 928.5)
477.3
(196.7, 757.8)
(17843.6, 37010.7)
6015.5
(3456.3, 8574.6)
4259.7
(2407.6, 6111.7)
1094.6
(97.0, 2092.2)
553.6
(268.1, 839.1)
(19374.9, 30526.4)
5155.7
(4151.4, 6160.1)
4495.3
(3651.8, 5338.9)
130.2
(65.7, 194.6)
318.3
(210.6, 426.1)
(31687.6, 92619.5)
36232.2
(20344.5, 52119.9)
33980.8
(19667.0, 48294.6)
635.0
(146.3, 1123.7)
604.7
(0.0, 1217.8)
(40545.4, 63585.9)
27276.3
(21134.1, 33418.4)
25723.2
(19826.2, 31620.3)
315.8
(209.6, 422.0)
272.8
(149.9, 395.6)
(1573.4, 9831.4)
7471.1
(4659.6, 10282.6)
7266.6
(4602.5, 9930.7)
0.0
2.3
-
172222.4
(127704.1,
216740.6)
141211.5
(107245.6,
175177.4)
1244.1
(522.4, 1965.7)
22774.3
(14604.5, 30944.1)
121375.7
(93393.8,
149357.7)
100806.5
(79164.4,
122448.6)
20569.2
(13184.2, 27954.3)
50846.7
(32850.7, 68842.6)
144872.3
(107490.9,
182253.6)
76135.3
(57265.1, 95005.4)
71465.9
(54206.1, 88725.7)
1081.0
(570.3, 1591.7)
1198.1
(511.1, 1885.1)
200888.9
(21378.1, 33491.9)
23935.1
78548.2
(42642.3,
114454.2)
60267.8
1. Any ACT
(AL) 
DHAPPQ
ACT)
QA ACT with the “green
leaf” logo
QA ACT without the
“green leaf” logo
(non-QA ACT)
2. Any non-artemisinin
therapy
Oral Quinine
Quinine IV/IM
www.ACTwatch.info
(150901.5, 250876.3)
168811.9
(129203.6, 208420.2)
1244.1
(522.4, 1965.7)
23798.4
(15505.5, 32091.2)
148392.0
(114362.3, 182421.7)
114630.9
(89053.6, 140208.3)
33728.3
(23609.8, 43846.8)
52496.9
(34187.7, 70806.1)
172299.4
(129816.7, 214782.1)
82150.7
(62899.2, 101402.3)
75725.5
(58320.0, 93131.1)
2175.6
(1046.2, 3305.0)
1751.7
(970.0, 2533.4)
Page 155
Table X10: Antimalarial volumes, by outlet type
AETDs sold or distributed in the
previous week by outlet type
and antimalarial type:*
3. Oral artemisinin
monotherapy
4. Non-oral artemisinin
monotherapy
5. Any treatment for severe
malaria
Public
Health
Facility
# AETD (95% CI)
ALL
Public / Not ForProfit
# AETD (95% CI)
Private
For-Profit
Facility
# AETD (95% CI)
0.0
296.2
(148.1, 444.2)
277.4
(129.2, 425.6)
18.8
0.0
773.5
(461.0, 1085.9)
26928.3
0.0
606.3
(306.2, 906.4)
282.3
(130.1, 434.5)
324.0
(43.1, 604.9)
0.0
1159.9
(741.2, 1578.6)
35288.2
22.1
978.2
(680.7, 1275.6)
183.3
721.4
(488.0, 954.8)
73.4
(3.3, 143.6)
1296.5
(930.7, 1662.4)
33591.0
(17583.9, 36272.6)
(24494.8, 46081.6)
(26918.9, 40263.1)
Registered
Pharmacy
Unregistered
Pharmacy
General retailer
TOTAL
Private
ALL Outlets
# AETD (95% CI)
# AETD (95% CI)
# AETD (95% CI)
# AETD (95% CI)
# AETD (95% CI)
0.0
1711.9
46.7
(0.0, 146.0)
1639.6
25.7
(9.4, 41.9)
2316.6
(728.9, 3904.4)
116492.3
(65563.6,
167421.0)
0.0
645.4
(150.9, 1139.8)
218.4
(0.0, 700.5)
422.9
(162.7, 683.1)
4.1
(0.0, 8.4)
918.1
(375.4, 1460.9)
87616.4
(68865.8,
106366.9)
0.0
0.0
0.0
0.0
0.0
2.3
14015.5
22.1
3335.4
(1722.6, 4948.3)
448.4
2783.8
(1429.9, 4137.8)
103.2
(24.2, 182.2)
4533.5
(2291.7, 6775.4)
251715.2
(188246.2,
315184.1)
22.1
3941.7
(2125.8, 5757.6)
730.7
(300.5, 1161.0)
3107.8
(1628.3, 4587.4)
103.2
(24.2, 182.2)
5693.4
(3206.9, 8179.9)
287003.4
(8030.8, 20000.2)
(217361.4, 356645.4)
*
A total of 35645.3 AETDs were reportedly sold or distributed in the previous seven days. See Annex 11 for a description of AETD calculation.
At the time of the 2014 ACTwatch outlet survey artemether lumefantrine was Kenya's first line treatment for uncomplicated malaria.
A total of 6,651 antimalarials were audited in the census clusters. Of these, 325 audited antimalarials were not included in market share calculations due to incomplete or inconsistent information.

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Page 156
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Kenya Outlet Report 2014

Transcription

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