BackgroundEfforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home management of malaria strategy. However under this strategy, children with other illnesses were often wrongly treated with anti-malarials. Integrated community case management of common childhood illnesses is now recommended but its effect on promptness of appropriate pneumonia treatment is unclear.ObjectivesTo determine the effect of integrated malaria and pneumonia management on receiving prompt and appropriate antibiotics for pneumonia symptoms and treatment outcomes as well as determine associated factors.MethodsA follow-up study was nested within a cluster-randomized trial that compared under-five mortality in areas where community health workers (CHWs) treated children with malaria and pneumonia (intervention areas) and where they treated children with malaria only (control areas). Children treated by CHWs were enrolled on the day of seeking treatment from CHWs (609 intervention, 667 control) and demographic, illness, and treatment seeking information was collected. Further information on illness and treatment outcomes was collected on day four. The primary outcome was prompt and appropriate antibiotics for pneumonia symptoms and the secondary outcome was treatment outcomes on day four.ResultsChildren in the intervention areas were more likely to receive prompt and appropriate antibiotics for pneumonia symptoms compared to children in the control areas (RR = 3.51, 95%CI = 1.75-7.03). Children in the intervention areas were also less likely to have temperature ≥37.5°C on day four (RR = 0.29, 95%CI = 0.11-0.78). The decrease in fast breathing between day one and four was greater in the intervention (9.2%) compared to the control areas (4.2%, p-value = 0.01).ConclusionsIntegrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes.Trial registrationISRCTN: ISRCTN52966230

In Uganda, vaccine dose administration data are often not available or are of insufficient quality to optimally plan, monitor, and evaluate program performance. A collaboration of partners aimed to address these key issues by deploying data improvement teams (DITs) to improve data collection, management, analysis, and use in district health offices and health facilities. During November 2014–September 2016, DITs visited all districts and 89% of health facilities in Uganda. DITs identified gaps in awareness and processes, assessed accuracy of data, and provided on-the-job training to strengthen systems and improve healthcare workers’ knowledge and skills in data quality. Inaccurate data were observed primarily at the health facility level. Improvements in data management and collection practices were observed, although routine follow-up and accountability will be needed to sustain change. The DIT strategy offers a useful approach to enhancing the quality of health data.

Background Globally, suboptimal vaccine coverage is a public health concern. According to Uganda’s 2016 Demographic and Health Survey, only 49% of 12- to 23-month-old children received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage, reduce dropout, and increase awareness among caregivers to bring children for timely vaccination. Objective This study evaluates a personalized, automated caregiver mobile phone–delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children aged 12 months and younger in select health facilities in Arua district. Methods A two-arm, multicenter, parallel group randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers of children between 6 weeks and 6 months of age at the time of their first dose of pentavalent vaccine (Penta1; containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens) were recruited and interviewed. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers as available and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Text message reminders for Penta2 were sent 2 days before, on the day of, and 2 days after the scheduled vaccination visit. Reminders for Penta3 and the measles-containing vaccine were sent on the scheduled day of vaccination and 5 and 7 days after the scheduled day. Study personnel conducted postintervention follow-up interviews with participants at the health facilities during the children’s measles-containing vaccine visit. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention, economic data were collected to evaluate the incremental costs and cost-effectiveness of the intervention, and health facility record review forms were completed to capture service delivery process indicators. Results Of the 3485 screened participants, 1961 were enrolled from a sample size of 1962. Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children’s vaccination cards, data extraction from the health facility immunization registers, completion of the health facility record review forms, and focus group discussions were completed by December 2017. The results are expected to be released in 2021. Conclusions Prompting health-seeking behavior with reminders has been shown to improve health intervention uptake. Mobile phone ownership continues to grow in Uganda, so their use in vaccination interventions such as this study is logical and should be evaluated with scientifically rigorous study designs. Trial Registration ClinicalTrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485 International Registered Report Identifier (IRRID) DERR1-10.2196/17262

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BACKGROUND Globally, suboptimal vaccine coverage is a major public health concern. According to Uganda’s 2016 Demographic and Health Survey, only 49% of 12-23 month olds had received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage and reduce drop-out, including increasing awareness of caregivers to bring children for timely vaccination. This research builds upon a growing mobile health system in Uganda to use personalized, automated text messages to remind caregivers of upcoming vaccination visits. OBJECTIVE To evaluate a personalized, automated caregiver mobile phone delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children 12 months of age and younger in select health facilities in Arua District. METHODS A two arm, multi-center, parallel groups randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers were recruited and interviewed at the time of their children’s first dose of pentavalent vaccine (containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens), typically at 6 weeks of age of the child. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers, as available, and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not to receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Study personnel conducted post-intervention follow-up interviews with participants at the health facilities during the children’s measles-containing vaccine visit or outside the health facility (generally at the caregiver’s home) after the last child in the study reached one year of age; a questionnaire was administered and data from the child’s vaccination card was extracted. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention; economic data was collected to evaluate the incremental costs and the cost-effectiveness of the intervention; and health facility records review forms were completed to capture service delivery process indicators. RESULTS Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children’s vaccination cards; data extraction from the health facility immunization registers; completion of the health facility records review forms; and focus group discussions were completed by December 2017. CONCLUSIONS Prompting of health seeking behavior with reminders has been shown to improve health intervention uptake in many contexts, including via mobile technology. Mobile phone ownership continues to grow in Uganda, so their use in health interventions like this study is logical and should be evaluated with scientifically rigorous study designs. CLINICALTRIAL Clinicaltrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485.