1921
Volume 102, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

The main objective of this study was to assess whether training of private health providers and community sensitization on the importance of effective prompt care seeking and the need for referral could improve treatment of sick children in the private health sector in Uganda. Private providers were trained to diagnose and treat sick children according to the integrated community case management (iCCM) guidelines. In the control arm, routine services were offered. The outcomes were seeking care within 24 hours of onset of symptoms and appropriate case management for malaria, pneumonia, and diarrhea among children aged < 5 years. A total of 10,809 sick children (5,955 in the intervention arm and 4,854 in the control arm) presented for diagnosis and treatment. The percentage seeking care within 24 hours of onset of symptoms was 45.4% (95% CI 36.0–48.8) in the intervention arm versus 43.9% (95% CI 38.1–49.8) in the control arm ( = 0.04). Adherence to malaria rapid diagnostic test (mRDT) results was high, with 1,459 (94.3%) in the intervention arm versus 1,402 (83.0%) in the control arm ( = 0.04). Appropriate treatment of mRDT-positive children with artemisinin-based combination therapy was seen in 93.1% (95% CI 88.5–97.7) in the intervention arm versus 85.1% (95% CI 78.6–91.7) in the control arm ( = 0.03). Adherence to iCCM guidelines was very high: 89.1% of children with diarrhea in the intervention arm and 80.4% in the control arm were given oral rehydration salts and zinc ( = 0.01). Of the children with a respiratory rate > 40 breaths/minute, 1,596 (85.1%) in the intervention arm versus 104 (54.5%) in the control arm were given amoxicillin ( = 0.01). In conclusion, the intervention improved treatment of malaria, pneumonia, and diarrhea because of provider adherence to treatment guidelines. The policy implications of these findings are to initiate a dialogue at district and national levels on how to scale up the intervention in the private sector. NCT02450630 registered with ClinicalTrials.gov: May 9, 2015.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.19-0367
2020-01-20
2020-09-29
Loading full text...

Full text loading...

/deliver/fulltext/14761645/102/3/tpmd190367.html?itemId=/content/journals/10.4269/ajtmh.19-0367&mimeType=html&fmt=ahah

References

  1. Uganda Bureau of Statistics, 2016. Uganda Demographic and Health Survey. Kampala, Uganda: Bureau of Statistics.
    [Google Scholar]
  2. Uganda Bureau of Statistics, 2017. Uganda National Household Survey. Kampala, Uganda: Bureau of Statistics.
    [Google Scholar]
  3. Awor P, Wamani H, Bwire G, Jagoe G, Peterson S, 2012. Private sector drug shops in integrated community case management of malaria, pneumonia, and diarrhea in children in Uganda. Am J Trop Med Hyg 87 (Suppl 5): 9296.
    [Google Scholar]
  4. Awor P, Wamani H, Tylleskar T, Jagoe G, Peterson S, 2014. Increased access to care and appropriateness of treatment at private sector drug shops with integrated management of malaria, pneumonia and diarrhea: a quasi–experimental study in Uganda. PLoS One 9: e115440.
    [Google Scholar]
  5. Awor P, Wamani H, Tylleskar T, Peterson S, 2015. Drug seller adherence to clinical protocols with integrated management of malaria, pneumonia and diarrhea at drug shops in Uganda. Malar J 14: 277.
    [Google Scholar]
  6. Kitutu FE, Kalyango JN, Mayora C, Selling KE, Peterson S, Wamani H, 2017. Integrated community case management by drug sellers influences appropriate treatment of pediatric febrile illness in South western Uganda: a quasi– experimental study. Malar J 16: 425.
    [Google Scholar]
  7. Awor P, Miller J, Peterson S, 2014. Systematic literature review of integrated community case management and the private sector in Africa: relevant experiences and potential next steps. J Glob Health 4: 020414.
    [Google Scholar]
  8. Mbonye AK, Magnussen P, Lal S, Hansen KS, Cundill B, Chandler C, Clarke SE, 2015. A cluster randomized trial introducing rapid diagnostic tests into registered drug shops in Uganda: impact on appropriate treatment of malaria. PLoS One 10: e0129545.
    [Google Scholar]
  9. Ministry of Health/UNICEF/WHO, 2010. Integrated Community Case Management of Childhood Malaria, Pneumonia and Diarrhoea: Implementation Guide. Kampala, Uganda: Ministry of Health.
    [Google Scholar]
  10. Rutebemberwa E, Buregyeya E, Lal S, Clarke SE, Hansen KS, Magnussen P, LaRussa P, Mbonye AK, 2016. Assessing the potential of rural and urban private facilities in implementing child health interventions in Mukono district, central Uganda-a cross sectional study. BMC Health Serv Res 16: 268.
    [Google Scholar]
  11. Mbonye AK, Buregyeya E, Rutebemberwa E, Clarke SE, Lal S, Hansen KS, Magnussen P, LaRussa P, 2016. Prescription for antibiotics at drug shops and strategies to improve quality of care and patient safety: a cross–sectional survey in the private sector in Uganda. BMJ Open 6: e010632.
    [Google Scholar]
  12. Mbonye AK, Buregyeya E, Rutebemberwa E, Clarke SE, Lal S, Hansen KS, Magnussen P, LaRussa P, 2017. Referral of children seeking care at private health facilities in Uganda. Malar J 16: 76.
    [Google Scholar]
  13. Mbonye AK, Ndyomugyenyi R, Turinde A, Magnussen P, Clarke S, Chandler C, 2010. The feasibility of introducing rapid diagnostic tests for malaria in drug shops in Uganda. Malar J 9: 367.
    [Google Scholar]
  14. Uganda Bureau of Statistics, 2014. Uganda Population and Housing Census. Kampala, Uganda: Uganda bureau of Statistics.
    [Google Scholar]
  15. Buregyeya E, Rutebemberwa E, LaRussa P, 2016. Mbonye. Strengthening referral of sick children from the private health sector and its impact on referral uptake in Uganda: a cluster randomized controlled trial protocol. BMC Health Serv Res 16: 646.
    [Google Scholar]
  16. World Health Organization, 2013. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. Geneva, Switzerland: WHO.
    [Google Scholar]
  17. Ministry of Health/UNICEF/WHO, 2010. Integrated Community Case Management of Childhood Malaria, Pneumonia and Diarrhoea Facilitator’s Guide: Caring for Newborns and Children in the Community. Kampala, Uganda: Ministry of Health.
    [Google Scholar]
  18. Ivers NM, Halperin IJ, Barnsley J, Grimshaw JM, Shah BR, Tu K, Upshur R, Zwarenstein M, 2012. Allocation techniques for balance at baseline in cluster randomized trials: a methodological review. Trials 13:120.
    [Google Scholar]
  19. Bennett S, Woods T, Liyanage WM, Smith DL, 1991. A simplified general method for cluster-sample surveys of health in developing countries. World Health Statist Quart 44: 98106.
    [Google Scholar]
  20. Peterson S, Nsungwa-Sabiiti J, Were W, Nsabagasani X, Magumba G, Nambooze J, Mukasa G, 2004. Coping with pediatric referral-Ugandan parents’ experience. Lancet 363:19551956.
    [Google Scholar]
  21. Hayes R, Moulton L, 2009. Cluster Randomized Trials. London, UK: Chapman and Hall.
    [Google Scholar]
  22. Oryema-Lalobo M, 2009. Community health seeking practices for the management of malaria of the under- five in Bugiri District, Uganda. East Afr J Public Health 6: 191.
    [Google Scholar]
  23. Achan J, Tibenderana J, Kyabayinze D, Mawejje H, Mugizi R, Mpeka B, Talisuna A, D’Alessandro U, 2011. Case management of severe malaria-a forgotten practice: experiences from health facilities in Uganda. PLoS One 6: e17053.
    [Google Scholar]
  24. Källander K, Tomson G, Nsungwa-Sabiiti J, Senyonjo Y, Pariyo G, Peterson S, 2006. Community referral in home management of malaria in western Uganda: a case series study. BMC Int Health Hum Rights 6: 2.
    [Google Scholar]
  25. Hutchinson E, Chandler C, Clarke S, Lal S, Magnussen P, Kayendeke M, Nabirye C, Kizito J, Mbonye A, 2015. “It puts life in us and we feel big”: Shifts in the local health care system during the introduction of rapid diagnostic tests for malaria into drug shops in Uganda. Crit Public Health 25: 4862.
    [Google Scholar]
  26. Embrey M et al., 2016. Understanding the role of accredited drug dispensing outlets in Tanzania’s health system. PLoS One 11: e0164332.
    [Google Scholar]
  27. Maloney K et al., 2017. Expanding access to parasite-based malaria diagnosis through retail drug shops in Tanzania: evidence from a randomized trial and implications for treatment. Malar J 16: 6.
    [Google Scholar]
  28. Ansah EK, Narh-Bana S, Affran-Bonful H, Bart-Plange C, Cundill B, Gyapong M, Whitty CJ, 2015. The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial. BMJ 350: h1019.
    [Google Scholar]
  29. Hopkins H et al., 2017. Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomized studies in public and private healthcare settings. BMJ 356: j1054.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.19-0367
Loading
/content/journals/10.4269/ajtmh.19-0367
Loading

Data & Media loading...

  • Received : 12 May 2019
  • Accepted : 17 Oct 2019
  • Published online : 20 Jan 2020
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error