Malaria healthcare policy change in Kenya: Implications on sales and marketing of antimalarials.

Background & objectives: Malaria healthcare policy change in Kenya aimed at improving the control of malaria but faced a number of challenges in implementation related to marketing of the drugs. This research investigated the effect of the change of the national malaria policy on drug sales and strategic marketing responses of antimalarial pharmaceutical companies in Kenya. Study design: A descriptive cross-sectional design was employed to describe the existing state of antimalarials market in Kenya after the change of the malaria healthcare policy. Results & conclusion: Policy change did result in an increase in the sales of Coartem®. Novartis Pharma recorded a 97% growth in sales of Coartem® between 2003 and 2004. However, this increase was not experienced by all the companies. Further, SPs (which had been replaced as first-line therapy for malaria) registered good sales. In most cases, these sales were higher than the sales of Coartem®. Generally, the sales contribution of SPs and generic antimalarial medicines exceeded that of Coartem® for most distributors. The most common change made to marketing strategies by distributors (62.5%) was to increase imports of antimalarials. A total of 40% of the manufacturers preferred to increase their budgetary allocation for marketing activities. In view of the fact that continued sale of SP drugs and limited availability of AL poses the risk of increasing the incidence of malaria in Kenya, it is therefore, recommended that pharmacy surveillance systems be strengthened to ensure drugs that have been rendered non-viable or that prescription-only medicines are not sold contrary to the national guidelines.

Factors Associated With the Motivation of Community Drug Distributors in the Lymphatic Filariasis Elimination Programme in Kenya

Annual mass drug administration (MDA) is the main strategy for elimination of lymphatic filariasis (LF); globally. In Kenya; community drug distributors (CDDs) are used to deliver drugs to household members. To determine factors influencing CDDs' motivation; a retrospective cross-sectional study based on qualitative data was conducted in Kwale and Malindi districts after the 2008 MDA. In Kwale; Tsimba location represented high and Gadini low compliance while in Malindi; Goshi and Gongoni locations represented high and low compliance areas; respectively. Fifteen CDDs; 80 opinion leaders; 80 LF patients; five health personnel; four LF coordinators and the National Programme Manager were purposively selected and interviewed. Sixteen focus group discussions (FGDs) were conducted with single-sex adult and youth male and female groups. The factors that possibly had a positive influence on CDDs' motivation were: higher education level; trust and familiarity with community members. All CDDs reported that getting recognised; being trained on LF and an innate desire to help their communities raised their motivation. Factors that possibly had negative influence included: inadequate training; drug supplies and community sensitisation and lack of supervision. The majority of the CDDs reported a lack of or outdated record-keeping books; a limited drug distribution period; inadequate moral support and incentives as negative factors on their motivation. Factors that motivate CDDs are those that enhance their capacities to perform their duties and endear respect in the communities where they serve

The potential of the extracts of Tagetes minuta Linnaeus (Asteraceae), Acalypha fruticosa Forssk (Euphorbiaceae) and Tarchonanthus camphoratus L. (Compositae) against Phlebotomus duboscqi Neveu Lemaire (Diptera: Psychodidae), the vector for Leishmania major Yakimoff and Schokhor.

Background & objectives: Harmful effects of synthetic chemical insecticides including vector resistance, environmental pollution and health hazards have necessitated the current significance in the search for plant-based insecticide products that are environmentally safe and effective to leishmaniases control. The insecticidal activity of Tagetes minuta Linnaeus (Asteraceae), Acalypha fruticosa Forssk (Euphorbiaceae) and Tarchonanthus camphoratus L. (Compositae) extracts were investigated against Phlebotomus duboscqi Neveu Lemaire (Diptera: Psychodidae). Methods: The extracts were prepared from dried aerial parts soaked in methanol and ethyl acetate twice until the filtrates became clear, filtered and dried out by rotary evaporation at 30–35oC. The solid extracts obtained were later prepared into 2.5, 5 and 10 mg/ml. Two millilitres of the solutions were blotted on filter papers, which were dried overnight and placed into jars where adult sandflies were aspirated. Males and females were assayed separately. Results & conclusion: The extracts had significant mortality (p<0.05) in both males and females bioassays but were not significantly different between sexes. The extracts of Acalypha fruticosa and Tagetes minuta had significantly higher mortality rates than those of Tarchonanthus camphoratus and the different concentrations used showed significantly different mortality rates and 10 mg/ml was the most effective concentration. Cent percent mortality was obtained at 96 h of exposure to 5 and 10 mg/ml concentrations except for Tarchonanthus camphoratus which had a mortality of only 46.7% in 10 mg/ml bioassay. These extracts were found to be insecticidal to adult sandflies.

Experimental chemotherapy with Allium sativum (Liliaceae) methanolic extract in rodents infected with Leishmania major and Leishmania donovani.

Background & objectives: Several plant products have been tested and found to possess antileishmanial activity. The present study was undertaken to establish whether methanolic extract of Allium sativum Linn has antileishmanial activity in comparison to standard drugs. Methods: Methanolic extract of A. sativum bulbs was screened for in vitro and in vivo antileishmanial activity against Leishmania major strain (NLB 145) and L. donovani strain (NLB 065). Pentostam® and Amphotericin B® were used as standard drugs. BALB/c mice and golden hamsters (Mesocricetus auratus) were used in in vivo studies on L. major and L. donovani respectively. Results: The extract exhibited very low cytotoxicity (IC50 >450 μg/ml) against Vero cells. The extract had significantly better (p <0.001) leishmanicidal activity against both species (IC50 34.22 μg/ml to L. major, 37.41 μg/ml to L. donovani) than Pentostam. However, the activity was significantly lower (p <0.001) than that of Amphotericin B against both the species. At a concentration of 250 μg/ml, the extract induced the production of 60 μM of nitric oxide, a ten-fold up-regulation in activated macrophages. The multiplication indices for L. major amastigotes treated in 100 μg/ml were significantly different (p <0.05). Treatment with the extract, daily for 28 days led to a significant reduction (p <0.05) in footpad swelling in BALB/c mice; similar activity noticed in the treatment with standard drugs. The Leishman-Donovan Units (LDU) for the extract treated animals were significantly higher (p <0.05) than those of standard drugs, but lower compared to the negative control. Interpretation & conclusion: Since the mechanism of action for the methanolic extract is apparently immunomodulatory, garlic compounds could be purified and tried as complementary medicine in the management of leishmaniases.

Effects of long-lasting insecticidal nets and zooprophylaxis on mosquito feeding behaviour and density in Mwea, central Kenya.

Background & objectives: Zooprophylaxis is a strategy that can control malaria by attracting mosquitoes to domestic animals that act as dead-end hosts. The objective of this study was to establish the effects of zooprophylaxis and long-lasting insecticidal nets (LLINs) on malaria transmission in an agro-based ecosystem with seasonal transmission. Methods: The mosquito samples were collected indoors using the space spray catch method before and after intervention between October 2005 and March 2006 to determine the mosquito densities and the feeding patterns of Anopheles spp in Mwea, Kenya. Results: A total of 4148 mosquito samples were collected, out of which 11 (0.2%) were tested positive for sporozoites. Ten were Anopheles gambiae species and one was An. funestus species. Results on blood meal ELISA showed that in the household categories that used bednets and kept one cow there was a decrease in relative change ratio (post-/pre-intervention) of 87.5 and 19.6% (p <0.05) in human and cattle blood intake respectively. For households that kept 2–4 cattle and used bednets, there was a decrease in cattle blood index (CBI) by 61.9% and an increase in human blood index (HBI) by 2%, which was not significant (p >0.05). In households with >4 cattle and bednet, there was significant reduction (p <0.05) in CBI of 37.5% as compared to the reduction of 10.3% in HBI. The ratios of man biting rates (MBR) decreased significantly, as you move up from households with one cattle with or without LLINs to households with more than four cattle with or without LLINs with a regression coefficient of –0.96; SE = 0.834; p = 0.017. Similarly, the HBI decreased significantly with the regression coefficient of 0.239; SE = 0.039; p = 0.015 (p <0.05) especially in households with >4 cattle. Interpretation & conclusion: This study demonstrated that there were additive effects of zooprophylaxis and LLINs in the control of mosquito density and reduction of human risk to the mosquito bites. However, in Integrated Vector Management (IVM), the number of animals per household should not be more than four.