Matching policy with practice: effectively treating childhood fever in Kenya

Many believe that the key to reducing childhood mortality associated with malaria lies in effective, early treatment of fevers.  The kind of treatment sought, at what stage and from what service provider remains key to the effectiveness of fever treatment in young children. In Kenya, the gap between policy and practice remains. The quality and accessibility of care continues to be inconsistent across the public and private health sectors. Initiatives to promote behavioural change amongst users and improve physical access to services are a priority.

In April 2000, African Heads of State meeting in Abuja, Nigeria, committed themselves and their countries to ensuring that 60% of all fever cases will be treated within 24 hours of onset with safe, effective anti-malarial drugs by 2010.  What progress has been made in Kenya towards meeting this target? 

A study was conducted in December 2001 in four ecologically different districts in Kenya, in order to discover what treatment is provided, the sources of treatment, costs and timing, for fevers in children aged five years and under.  Approximately 2 500 homesteads were identified in each selected area and interviews were conducted in all homesteads.  One child aged under five was selected at random within each homestead as the subject of the study. The researchers and their field teams visited a total of 9 272 households with 18 983 resident children under five years old. 6 287 mothers or guardians were subsequently interviewed about fever in the preceding 14 days. 

The study revealed significant differences in fever prevalence between districts, which appear to correspond with their differing malarial ecologies.  During the period of study the overall prevalence of fever in children was 42.2%, revealing fever to be a common event in children. Of the fevers reported:

• 28.1% went untreated
• 29.5% were treated at public formal facilities
• 26.1% through the private retail sector

Differences were recorded between districts in fever treatment rates, treatment sources, cost and medication used. A substantial number of fevers were treated outside the formal public sector, using mostly western pharmaceuticals. Other findings included:

• There was a median waiting period of 2 days from onset of symptoms for any form of treatment across the four districts.
• Less than 3% of all reported fevers were treated within 24 hours with the nationally recognised first-line anti-malarial drug (sulphur-pyrimethamine).
• 8.3% of western medicines dispensed were unknown to respondents, almost all provided by government facilities.
• The formal public sector was the best source of early anti-malarial treatment, whilst the private retail sector had most potential for improving access to anti-malarial drugs.

There is a need to improve prescribing practices in private sector clinics and fever management practices at home. In the retail sector second-line drugs are often available, pointing to a need for improved engagement of retailers with policy, so as to restrict the availability of second-line drugs and promote access to first-line recommended drugs.

There is a huge gap between policy - as set out in the Abuja declaration - and practice.    Only 2.3% of cases were treated within 24 hours using the recommended first line treatment for uncomplicated malaria in Kenya. If morbidity and mortality caused by malaria is to be halved by 2010, a major investment is needed in improving prompt access to anti-malarial drugs through initiatives to promote behaviour change and improved physical access.

Source(s):
‘The use of formal and informal curative services in the management of paediatric fevers in four districts in Kenya’, Tropical Medicine and International Health 8(12): 1143-1152, by A. A. Amin et al, 2003
'Changing home treatment of childhood fevers by training shopkeepers in rural Kenya', Tropical Medicine and International Health 4: 383-389, by V.M. Marsh et al, 1999
'Defining equity in physical access to clinical services using geographical information systems as part of malaria planning and monitoring in Kenya', Tropical Medicine and International Health 8: 917-926, by A. Noor et al, 2003

Funded by: The Roll Back Malaria Initiative (AFRO/WHO); UK Department for International Development; Ministry of Health, Government of Kenya; Wellcome Trust (UK); Kenya Medical Research Institute

id21 Research Highlight: 4 March 2004

Further Information:
Abdinasir A. Amin
Kenya Medical Research Institute/Wellcome Trust Collaborative Programme
00100 GPO Nairobi
PO Box 43640
Nairobi
Kenya

Tel: +254 20 2720163/2715160
Fax: +254 20 2711673
Contact the contributor: aamin@wtnairobi.mimcom.net

Kenya Medical Research Institute/Wellcome Trust Collaborative Programme

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