Integrated community case management by drug sellers influences appropriate treatment of paediatric febrile illness in South Western Uganda: a quasi-experimental study

Malaria Journal

Research

Katarina Ekholm Selling¹  Joan Nakayaga Kalyango²  Freddy Eric Kitutu³  Henry Wamani⁴  Stefan Peterson⁵  Chrispus Mayora⁶ 

[1] International Maternal and Child Health Unit, Department of Women’s and Children’s Health, Uppsala University, 751 85, Uppsala, Sweden;Pharmacy Department, Makerere University College of Health Sciences, Kampala, Uganda;Clinical Epidemiology and Biostatistics Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda;Pharmacy Department, Makerere University College of Health Sciences, Kampala, Uganda;School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda;International Maternal and Child Health Unit, Department of Women’s and Children’s Health, Uppsala University, 751 85, Uppsala, Sweden;School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda;School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda;International Maternal and Child Health Unit, Department of Women’s and Children’s Health, Uppsala University, 751 85, Uppsala, Sweden;Health Section, UNICEF, 3 UN Plaza, 10017, New York, NY, USA;School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda;School of Public Health, University of Witwatersrand, 27 St. Andrews Road, Parktown, 2193, Johannesburg, South Africa;

关键词: Integrated case management;    Drug sellers;    Uganda;    Febrile illness;    Malaria;    Pneumonia;    Private sector;    Diagnostics;    Appropriate treatment;   

DOI  :  10.1186/s12936-017-2072-9

 received in 2017-06-13, accepted in 2017-10-17,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundFever case management is a major challenge for improved child health globally, despite existence of cheap and effective child survival health technologies. The integrated Community Case Management (iCCM) intervention of paediatric febrile illnesses though adopted by Uganda’s Ministry of Health to be implemented by community health workers, has not addressed the inaccess to life-saving medicines and diagnostics. Therefore, the iCCM intervention was implemented in private drug shops and evaluated for its effect on appropriate treatment of paediatric fever in a low malaria transmission setting in South Western Uganda.MethodsFrom June 2013 to September 2015, the effect of the iCCM intervention on drug seller paediatric fever management and adherence to iCCM guidelines was assessed in a quasi-experimental study in South Western Uganda. A total of 212 care-seeker exit interviews were done before and 285 after in the intervention arm as compared to 216 before and 268 care-seeker interviews at the end of the study period in the comparison arm. The intervention effect was assessed by difference-in-difference analysis of drug seller treatment practices against national treatment recommendations between the intervention and comparison arms. Observed proportions among care-seeker interviews were compared with corresponding proportions from 5795 child visits recorded in patient registries and 49 direct observations of drug seller–care-seeker encounters in intervention drug shops.ResultsThe iCCM intervention increased the appropriate treatment of uncomplicated malaria, pneumonia symptoms and non-bloody diarrhoea by 80.2% (95% CI 53.2–107.2), 65.5% (95% CI 51.6–79.4) and 31.4% (95% CI 1.6–61.2), respectively. Within the intervention arm, drug seller scores on appropriate treatment for pneumonia symptoms and diagnostic test use were the same among care-seeker exit interviews and direct observation. A linear trend (negative slope, − 0.009 p value < 0.001) was observed for proportions of child cases prescribed any antimicrobial medicine in the intervention arm drug shops.ConclusionsThe iCCM intervention improved appropriate treatment for uncomplicated malaria, pneumonia symptoms and diarrhoea. Drug seller adherence to iCCM guidelines was high, without causing excessive prescription of antimicrobial medicines in this study. Further research should assess whether this effect is sustained over time and under routine supervision models.

【 授权许可】

CC BY   
© The Author(s) 2017