Changing home treatment of childhood fevers by training shop keepers in rural Kenya

BACKGROUND Malaria control in Africa relies primarily on early effective tr eatment for clinical disease, but most early treatments for fever occur thr ough self-medication with shop-bought drugs. Lack of information to communi ty members on over-the-counter drug use has led to widespread ineffective t reatment of fevers, increased risks of drug toxicity and accelerating drug resistance. We examined the feasibility and measured the likely impact of t raining shop keepers in rural Africa on community drug use. METHODS In a rural area of coastal Kenya, we implemented a shop keeper trai ning programme in 23 shops serving a population of approximately 3500, base d on formative research within the community We evaluated the training by m easuring changes in the proportions of drug sales where an adequate amount of chloroquine was purchased and in the percentage of home-treated childhoo d fevers given an adequate amount of chloroquine. The programme was assesse d qualitatively in the community following the shop keeper training. RESULTS The percentage of drug sales for children with fever which included an antimalarial drug rose from 34.3% (95% CI 28.9%-40.1%) before the train ing to a minimum of 79.3% (95% CI 71.8%-85.3%) after the training. The perc entage of antimalarial drug sales where an adequate amount of drug was purc hased rose from 31.8% (95% CI 26.6%-37.6%) to a minimum of 82.9% (95% CI 76 .3%-87.3%). The percentage of childhood fevers where an adequate dose of ch loroquine was given to the child rose from 3.7% (95% CI 1.2%-9.7%) before t he training to a minimum of 65.2% (95% CI 57.7%-72.0%) afterwards, which re p resents an increase in the appropriate use of over-the-counter chloroquin e by at least 62% (95% CI 53.7%-69.3%). Shop keepers and community members were strongly supportive of the aims and outcome of the programme. CONCLUSIONS The large shifts in behaviour observed indicate that the approa ch of training shop keepers as a channel for information to the community i s both feasible and likely to have a significant impact. Whilst some of the impact seen may be attributable to research effects in a relatively small scale pilot study, the magnitude of the changes support further investigati on into this approach as a potentially important new strategy in malaria co ntrol.