Kenya (2015): Evaluation of the Malaria Private Sector Rapid Diagnostic Testing Project in Kenyan Coast - Midline Household Survey Round 2.

Abstract In order to improve febrile case management in the private sector, in coordination with the relevant National Malaria Control Programs, a consortium of partners including Population Services International (PSI), Population Services Kenya (PS Kenya), and Malaria Consortium (MC) are implementing a five-country project funded by UNITAID. The project will operate in five target Affordable Medicines Facility-malaria (AMFm) countries: Kenya, Madagascar, Nigeria, Tanzania (mainland) and Uganda over a three-year period. The goal of the project is to increase the appropriate use of quality-assured RDTs in private sector outlets in beneficiary malaria-endemic countries by increasing uptake of RDTs in private sector markets through targeted activities. In order to monitor and assess the project, the Partnership will conduct research in the project areas. The evidence generated will be shared with key stakeholders including the National Malaria Control Programs, so that it can contribute to the improvement of febrile case management in these countries as well as inform the wider public health community. In Kenya, PS Kenya and the consortium partners will conduct research in the project areas of Kwale, Mombasa and Kilifi counties in the Coast province. The primary research objective is to assess the level and quality of reported RDT use among patients seeking treatment in the private sector. Secondary objectives are to assess: a) Patients’ treatment-seeking behaviours; b) The extent of patients’ malaria knowledge; c) The effect of provider and client behaviour change communication (BCC) interventions; and d) Providers’ and patients’ trust in RDTs, compared to microscopy and presumptive treatment. A combination of methods will be used to meet these objectives. The project will involve four primary data collection activities: (1) client exit interviews with adult clients exiting participating facilities; (2) mystery client surveys which will involve using trained participants to visit participating facilities enacting the role of shoppers or clients; (3) short household surveys with caregivers of children under five to track exposure to and knowledge of project messaging; and (4) in-depth interviews with providers and patients to investigate trust in RDTs as a diagnostic tool when compared to microscopy and presumptive treatment for malaria. This study design covers the third and fourth data collection activities under the project: household surveys to monitor exposure to project demand creation activities and in-depth interviews with patients/caregivers and providers. This study protocol relates to the first two data collection activities under the project: client exit interviews and mystery client surveys. The sampling frame will be drawn from 2009 census data sourced from the Kenya National Bureau of Statistics. As the present-day counties did not exist in the same form in 2009, lower-level administrative units will be matched to present-day Kwale, Mombasa and Kilifi in discussion with local staff from PS Kenya’s regional office. At the first stage of selection a random sample of 18 sub-locations in Kwale and 23 sub-locations in Mombasa/Kilifi will be made from the full list of sub-locations within each domain. At the second stage, 1 village will be sampled from each sub-location at random, based on the information sourced from local-leaders within a sub-location. At the third stage 30 households will be approached for screening in each selected village. In this manner 540 households will be approached in Kwale and 690 households approached in Mombasa and Kilifi. Interviews will be conducted with primary caregivers of children under five years of age living in the project areas. Household survey analysis will account for the clustered sampling strategy and be conducted at the individual-level. The study protocol and informed consent forms for this research will be reviewed and approved by the Ethics & Scientific Review Committee (ESRC) of AMREF Kenya. Primary data collection will be conducted in the month of February-March 2015.