Design of a cluster randomized trial assessing integrated infectious diseases training and on-site support for midlevel practitioners in Uganda

Naikoba, Sarah; Colebunders, Robert; Geertruyden, Jean‐Pierre Van; Willis, Kelly S.; Kinoti, Stephen N.; Kulubya, Milly Namaalwa; Mbonye, Martin; Miceli, Antonina; Mpanga-Sebuyira, Lydia; Ronald, Allan; Scheld, Michael; Weaver, Marcia R.

doi:10.1177/2040402613479342

Cited by 12 publications

(48 citation statements)

References 24 publications

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“…Each monthly OSS session was devoted to a specific topic and all OSS topics are reported in Miceli et al, and Naikoba et al [13], [15]. The second monthly topic was fever case management.…”

Section: Methodsmentioning

confidence: 99%

Effect of Integrated Capacity-Building Interventions on Malaria Case Management by Health Professionals in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components

Mbonye

Burnett

Burua³

et al. 2014

PLoS ONE

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BackgroundThe Integrated Infectious Diseases Capacity Building Evaluation (IDCAP) designed two interventions: Integrated Management of Infectious Disease (IMID) training program and On-Site Support (OSS). We evaluated their effects on 23 facility performance indicators, including malaria case management.MethodologyIMID, a three-week training with two follow-up booster courses, was for two mid- level practitioners, primarily clinical officers and registered nurses, from 36 primary care facilities. OSS was two days of training and continuous quality improvement activities for nine months at 18 facilities, to which all health workers were invited to participate. Facilities were randomized as clusters 1∶1 to parallel OSS “arm A” or control “arm B”. Outpatient data on four malaria case management indicators were collected for 14 months. Analysis compared changes before and during the interventions within arms (relative risk = RR). The effect of OSS was measured with the difference in changes across arms (ratio of RR = RRR).FindingsThe proportion of patients with suspected malaria for whom a diagnostic test result for malaria was recorded decreased in arm B (adjusted RR (aRR) = 0.97; 99%CI: 0.82,1.14) during IMID, but increased 25% in arm A (aRR = 1.25; 99%CI:0.94, 1.65) during IMID and OSS relative to baseline; (aRRR = 1.28; 99%CI:0.93, 1.78). The estimated proportion of patients that received an appropriate antimalarial among those prescribed any antimalarial increased in arm B (aRR = 1.09; 99%CI: 0.87, 1.36) and arm A (aRR = 1.50; 99%CI: 1.04, 2.17); (aRRR = 1.38; 99%CI: 0.89, 2.13). The proportion of patients with a negative diagnostic test result for malaria prescribed an antimalarial decreased in arm B (aRR = 0.96; 99%CI: 0.84, 1.10) and arm A (aRR = 0.67; 99%CI: 0.46, 0.97); (aRRR = 0.70; 99%CI: 0.48, 1.00). The proportion of patients with a positive diagnostic test result for malaria prescribed an antibiotic did not change significantly in either arm.InterpretationThe combination of IMID and OSS was associated with statistically significant improvements in malaria case management.

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“…Each monthly OSS session was devoted to a specific topic and all OSS topics are reported in Miceli et al, and Naikoba et al [13], [15]. The second monthly topic was fever case management.…”

Section: Methodsmentioning

confidence: 99%

Effect of Integrated Capacity-Building Interventions on Malaria Case Management by Health Professionals in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components

Mbonye

Burnett

Burua³

et al. 2014

PLoS ONE

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“…This is a cross sectional study that analyzes baseline data collected prior to a large mixed design intervention study described in Naikoba et al [ 30 ]. After these baseline data were collected, two IDCAP interventions were implemented 1) the Integrated Management of Infectious Diseases (IMID) course and 2) on-site support.…”

Section: Methodsmentioning

confidence: 99%

“…On-site support was training and continuous quality improvement which took place at a random sample of 18 of the 36 health facilities. All health workers were invited to participate in the on-site support training as described in Naikoba et al [ 30 ] and Miceli et al [ 26 ].…”

Section: Methodsmentioning

confidence: 99%

“…The Integrated Infectious Disease Capacity Building Evaluation (IDCAP) sought to estimate the effect of a training program followed by on-site support (OSS) [ 26 ] on individual clinical competence [ 27 ] and practice, facility-level performance [ 28 , 29 ], and population-based mortality of children under five. To measure facility performance, the IDCAP evaluation team cooperated with the Uganda MoH to improve the quality of HMIS data through provision of data entry staff and equipment, training and support of supervision visits [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

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Disease diagnosis in primary care in Uganda

et al. 2014

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BackgroundThe overall burden of disease (BOD) especially for infectious diseases is higher in Sub-Saharan Africa than other regions of the world. Existing data collected through the Health Management Information System (HMIS) may not be optimal to measure BOD. The Infectious Diseases Capacity Building Evaluation (IDCAP) cooperated with the Ugandan Ministry of Health to improve the quality of HMIS data. We describe diagnoses with associated clinical assessments and laboratory investigations of outpatients attending primary care in Uganda.MethodsIDCAP supported HMIS data collection at 36 health center IVs in Uganda for five months (November 2009 to March 2010) prior to implementation of the IDCAP interventions. Descriptive analyses were performed on a cross-sectional dataset of 209,734 outpatient visits during this period.ResultsOver 500 illnesses were diagnosed. Infectious diseases accounted for 76.3% of these and over 30% of visits resulted in multiple diagnoses. Malaria (48.3%), cough/cold (19.4%), and intestinal worms (6.6%) were the most frequently diagnosed illnesses. Body weight was recorded for 36.8% of patients and less than 10% had other clinical assessments recorded. Malaria smears (64.2%) and HIV tests (12.2%) accounted for the majority of 84,638 laboratory tests ordered. Fewer than 30% of patients for whom a laboratory investigation was available to confirm the clinical impression had the specific test performed.ConclusionsWe observed a broad range of diagnoses, a high percentage of multiple diagnoses including true co-morbidities, and underutilization of laboratory support. This emphasizes the complexity of illnesses to be addressed by primary healthcare workers. An improved HMIS collecting timely, quality data is needed. This would adequately describe the burden of disease and processes of care at primary care level, enable appropriate national guidelines, programs and policies and improve accountability for the quality of care.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2296-15-165) contains supplementary material, which is available to authorized users.

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“…More about the project design and implementation is given in [16,19] and IMID and OSS have been described in [15].…”

Section: Imid and Ossmentioning

confidence: 99%

Evaluating the impact of two training interventions to improve diagnosis and case-management of malaria and pneumonia in Uganda

et al. 2016

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SUMMARYWe present an age-structured mathematical model of malaria and pneumonia to study the effect of two capacity-building interventions: Integrated Management of Infectious Diseases (IMID) and On-site Support Services (OSS). IMID leads to a reduction in malaria prevalence by more than 2·4% across the [0,5), [5,14) and [14,50) age groups. IMID + OSS reduces it by more than 16·0% across all age groups. IMID decreases pneumonia prevalence by more than 3·0% across all age groups while IMID + OSS decreases it by more than 1·0% across all age groups. The number of malaria and pneumonia deaths is reduced by 7·8% by IMID across all age groups and IMID + OSS decreases this number by 30·5% across all age groups, which translates to saving a life of a child per month. Prevalence of malaria-pneumonia for the [0,5) age group is 0·52% at baseline, and IMID and IMID + OSS reduce it by 6·6% and 23·6%, respectively. There is no change in incidence of malaria or pneumonia disease episodes. The results also indicate that triaging of children contributes more than 50% to the effect of the interventions in reduction of deaths and a range of 14-91% in reduction of disease cases.

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Design of a cluster randomized trial assessing integrated infectious diseases training and on-site support for midlevel practitioners in Uganda

Cited by 12 publications

References 24 publications

Effect of Integrated Capacity-Building Interventions on Malaria Case Management by Health Professionals in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components

Effect of Integrated Capacity-Building Interventions on Malaria Case Management by Health Professionals in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components

Disease diagnosis in primary care in Uganda

Evaluating the impact of two training interventions to improve diagnosis and case-management of malaria and pneumonia in Uganda

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