02862nas a2200229   4500000000100000008004100001260001200042100001100054700001900065700001200084700001500096700001200111700002300123700001800146700001100164245010300175856009900278300001300377490000700390520222100397022001402618       2021                            d  c08/20211 aOoms G1 avan Oirschot J1 aOkemo D1 aWaldmann B1 aErulu E1 aMantel-Teeuwisse A1 avan den Ham H1 aReed T00aAvailability, affordability and stock-outs of commodities for the treatment of snakebite in Kenya.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0009702&type=printable  ae00097020 v153 a<p><b>BACKGROUND: </b>Annually, about 2.7 million snakebite envenomings occur globally. Alongside antivenom, patients usually require additional care to treat envenoming symptoms and antivenom side effects. Efforts are underway to improve snakebite care, but evidence from the ground to inform this is scarce. This study, therefore, investigated the availability, affordability, and stock-outs of antivenom and commodities for supportive snakebite care in health facilities across Kenya.</p><p><b>METHODOLOGY/PRINCIPAL FINDINGS: </b>This study used an adaptation of the standardised World Health Organization (WHO)/Health Action International methodology. Data on commodity availability, prices and stock-outs were collected in July-August 2020 from public (n = 85), private (n = 36), and private not-for-profit (n = 12) facilities in Kenya. Stock-outs were measured retrospectively for a twelve-month period, enabling a comparison of a pre-COVID-19 period to stock-outs during COVID-19. Affordability was calculated using the wage of a lowest-paid government worker (LPGW) and the impoverishment approach. Accessibility was assessed combining the WHO availability target (≥80%) and LPGW affordability (<1 day's wage) measures. Overall availability of snakebite commodities was low (43.0%). Antivenom was available at 44.7% of public- and 19.4% of private facilities. Stock-outs of any snakebite commodity were common in the public- (18.6%) and private (11.7%) sectors, and had worsened during COVID-19 (10.6% versus 17.0% public sector, 8.4% versus 11.7% private sector). Affordability was not an issue in the public sector, while in the private sector the median cost of one vial of antivenom was 14.4 days' wage for an LPGW. Five commodities in the public sector and two in the private sector were deemed accessible.</p><p><b>CONCLUSIONS: </b>Access to snakebite care is problematic in Kenya and seemed to have worsened during COVID-19. To improve access, efforts should focus on ensuring availability at both lower- and higher-level facilities, and improving the supply chain to reduce stock-outs. Including antivenom into Universal Health Coverage benefits packages would further facilitate accessibility.</p>  a1935-2735