(19) Peer Influence and the Management of Malaria Commodities in Kenya

Background: Proper management of antimalarials and laboratory supplies is key in the journey toward a malaria-free Kenya. The biannual malaria commodities review meeting brings together County Pharmacists, Sub-County Pharmacists, County Malaria Control Coordinators, County Medical Laboratory Technologists, and County Health Records and Information Officers from different epidemiological zones. The activity is supported by the malaria Global Fund grant and the Division of National Malaria Program (DNMP) to discuss the stock status at all levels, reporting rates for the commodity reporting tool (MOH 743), and the use of data for decision-making.

Methods: We developed a template with key data elements and data sets to be filled by the county teams. The completed templates were presented during the review meeting conducted between April and May 2022. During the presentations, we abstracted commodity data on an Excel spreadsheet tool designed to collect data on stock on hand and average monthly consumption of antimalarial medicines, test kits (mRDTs) derived from MOH 743 for 47 counties and laboratory reagents required for malaria microscopy derived from MOH 643. We analyzed the stock levels in the counties as of March 2022. We also analyzed the trends in reporting rates and data completeness for MOH 743, concordance between confirmed malaria cases and patients treated with Artemether-Lumefantrine (AL), overuse of AL, and data accuracy on the number of AL tablets dispensed for referral hospitals for each of the 47 counties. Continuous variables were presented as proportions and measures of central tendency and measures of dispersion.

Results: As of May 2022, the median months of stock (MOS) for AL in the counties was 9.8 (IQR 6.6 – 25.4). The median MOS for mRDTs was 6.4 (IQR 3.8 - 11.0). The malaria-endemic counties in Western and Coastal regions had an average of 3 MOS (SD 6.5) of Sulfadoxine-Pyrimethamine used for intermittent preventive therapy in pregnancy. The reporting rate for MOH 743 improved from 68% in 2016 to 98% in 2022. Of the 47 county referral hospitals, 37 (79%) had complete data on all data elements. Data concordance on the number of patients who tested positive for malaria and the number treated was observed in 6 (16%). The no. of tablets of AL dispensed was also correct in 16% of the hospitals. Overtreatment has reduced from 25% in 2018 to 2% in 2021. The lab reagents data was not analyzed due to huge data discrepancies and multiple reporting tools.

Conclusion: Malaria commodities were not optimally stocked at the health facilities. Data discrepancies suggest gaps in reporting and nonadherence to malaria treatment guidelines. Laboratory reagents data need to be reported in a standard tool. The county health teams and DNMP to conduct stock audits, followed by redistribution of commodities for optimal stocking at all facilities. DNMP to mentor county and sub county teams on malaria commodity management. Counties sub-counties, and facilities to conduct regular data review meetings to resolve discrepancies.

Keywords: Malaria, peer influence, antimalarials, supplies, data accuracy