One stop shop? care trajectories for pediatric febrile illness episodes among caregivers who seek care at private pharmacies in Kenya

Febrile illness remains a leading cause of serious illness and death for children in Kenya and throughout sub-Saharan Africa, where barriers to care force caregivers to navigate a complex mix of providers, including pharmacies. Yet relatively little is known about how caregivers who seek care are pharmacies choose among multiple care options when seeking treatment for childhood fever or how pharmacies fit within that continuum of care. Data were collected at a sample ( n = 39) of private, stand-alone pharmacies in malaria-endemic counties in Kenya. This paper uses a cohort design, with data collected through an in-person survey at an index pharmacy visit and a phone survey administered two weeks later, to examine the characteristics of care-seeking decisions made throughout a given pediatric febrile illness episode. The primary outcome is a categorical variable for the care-seeking trajectories reported by respondents who participated in both surveys for the target child fever illness episode: (a) single visit at pharmacy, (b) pharmacy visit followed by a second visit elsewhere (pharmacy or clinic), or (c) initial visit elsewhere (pharmacy or clinic) followed by pharmacy visit. Data from 239 febrile illness episodes were analyzed using means comparisons and multinomial logistic regression with Lasso-selected covariates. Among the sample of caregivers who sought care at a pharmacy, 83.3% of child fever cases are managed entirely within one pharmacy visit at the sample pharmacy, 7.9% sought care at another care location (clinic, hospital or pharmacy) and then sought additional care at the sample pharmacy, and 8.8% first visited the sample pharmacy and then sought subsequent care at a clinic or pharmacy; 87% of child fever cases presenting in pharmacies are being managed entirely within pharmacies. In exploratory analysis, child age and number of symptoms were associated with care-seeking trajectories. Caregivers with infants were significantly less likely to manage pediatric febrile illness in a single pharmacy visit (–12.8 percentage points; 95% CI: –26.5,1.0), as well as those whose children had more self-reported symptoms: each additional symptom reduced this likelihood by 3.6 percentage points (95% CI: –6.8, –0.5). This study finds that when they are used, pharmacies are often the only source of care for childhood fevers. Furthermore, care pathways differed by markers of perceived need, with caregivers of infants and those reporting more symptoms less likely to seek care in a single pharmacy visit. These descriptive findings suggest that pharmacies should be better integrated into formal fever management systems, with particular attention to supporting pharmacists in recognizing severe cases and facilitating referrals, especially for infants and children with multiple symptoms. Not applicable.