Effectiveness of Social Networks in Enhancing the Uptake of Artemisinin-Based Combination Therapy (ACT) In Malaria-Prone Zones of Kenya

Abstract

Background: Malaria remains an important health issue in Kenya, with those below five years being most vulnerable to its severe consequences. Artemisinin-based combination therapy (ACT) is generally preferred for treating uncomplicated malaria, although its promotion is not balanced due to variations in socio-economic settings, geographical disparities, and social networks. It would be crucial to gain an understanding of the impact of social networks, specifically those defined by religious affiliations, on ACT to formulate appropriate strategies for improving outcomes for those affected by malaria in areas identified to be prone to it. Methods: Data for this research were drawn from the Kenya Malaria Indicator Survey, conducted in 2020, which adopted a cross-sectional design with stratified two-stage cluster sampling. For analysis, it included socio-demographic variables, geographic variation, and social network effects via religious affiliations. Differences were evaluated via chi-squared tests for independence for categorical variables, while t-tests or, for non-normal distributions, MannWhitney tests for normally or not-normally distributed variables, respectively. Logistic regression analysis was employed to ascertain individual, caregiver, religion, or setting-related predictors for ACT drug use. Results: ACT uptake among children under five was 52%. Male children were less likely to receive ACTs, with probabilities 6.3% lower in rural areas and 3.1% lower in urban areas. Younger children in rural areas, particularly those aged one, had a 5.7% higher likelihood of ACT usage, while uptake declined with age. Caregivers' education significantly enhanced ACT uptake in rural areas, increasing the likelihood by 25%. Rural Muslim households were 17.2% more likely to use ACTs, while urban Christian households showed modest improvements. Wealth disparities also affected uptake, with wealthier urban households less likely to use ACTs. Conclusion: This study emphasizes how social networks and especially religious connections significantly influence ACT uptake in areas of Kenya affected by malaria. By using these networks to address obstacles to access, there is strong potential to boost the use of ACT and improve health outcomes. Community-based strategies and partnerships with religious organizations may help ensure fairer malaria treatment for at-risk groups.