Drug seller adherence to clinical protocols with integrated management of malaria, pneumonia and diarrhoea at drug shops in Uganda

Awor, Phyllis; Wamani, Henry; Tylleskär, Thorkild; Peterson, Stefan

doi:10.1186/s12936-015-0798-9

Cited by 39 publications

(43 citation statements)

References 20 publications

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“…The Public-Private-Partnership policy framework stipulates that service delivery should utilize each sector's comparative advantage [24]. Subsidized drugs for epilepsy could be distributed in the private sector like it has been done for malaria drugs and with adequate supervision, this would increase access and still maintain quality services [25].…”

Section: Discussionmentioning

confidence: 99%

Biomedical drugs and traditional treatment in care seeking pathways for adults with epilepsy in Masindi district, Western Uganda: a household survey

Rutebemberwa

Ssemugabo

Tweheyo

et al. 2020

BMC Health Serv Res

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Background: Many patients with epilepsy in sub-Saharan Africa do not receive adequate treatment. The purpose of the study was to identify the health care providers where patients with epilepsy sought care and what treatment they received. Methods: A cross sectional study was conducted across 87 out of 312 villages in Masindi district. A total of 305 households having patients with epilepsy were surveyed using an interviewer administered questionnaire. Data was entered and analysed in Epi-info ver 7 for univariate and bivariate analysis, and in Stata SE ver 15.0 for multivariable analysis. Sequences of health providers consulted in care seeking, rationale and drugs used, and factors associated with choice of provider were assessed. Results: A total of 139 out of 305 (45.6%) households offered some treatment regimen at home when patients got symptoms of epilepsy with 44.6% (62/139) giving herbs and 18.0% (25/139) offering prayers. Eight different types of providers were consulted as first contact providers for treatment of epilepsy. Health centres received the highest percentage 35.4% (108/305) followed by hospitals 20.9% (64/305). A total of 192 of 305 (63.0%) households received anti-epileptic drugs, 13.1% (40/305) received prayers and 21.6% (66/305) received herbs at the first contact care seeking. Compared to a health centre as the first choice provider, other facilities more significantly visited were; hospitals if they were perceived as nearer (adj. Coeff 2.16, 95%CI 0.74, 3.59, p = 0.003), churches / mosques if cure for epilepsy was expected (adj. Coeff 1.91, 95%CI 0.38, 3.48, p = 0.014), and traditional healer for those aged ≥46 years (adj. Coeff 5.83, 95%CI 0.67, 10.99, p = 0.027), and friends/neighbour for traders (adj. Coeff 2.87, 95%CI 0.71, 5.04, p = 0.009). Conclusion: Patients with epilepsy seek treatment from multiple providers with the public sector attending to the biggest proportion of patients. Engaging the private sector and community health workers, conducting community outreaches and community sensitization with messages tailored for audiences including the young, older epileptics, traditional healers as stakeholders, and traders could increase access to appropriate treatment for epilepsy.

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Section: Discussionmentioning

confidence: 99%

Biomedical drugs and traditional treatment in care seeking pathways for adults with epilepsy in Masindi district, Western Uganda: a household survey

Rutebemberwa

Ssemugabo

Tweheyo

et al. 2020

BMC Health Serv Res

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“…Such targeting would also help reduce significant inequities found in malaria diagnosis, which must be addressed going forward. Integrated community case management with RDT-based malaria diagnosis has been successfully piloted in a number of settings by both community health workers and drug shop owners (39, 40), and it is a promising approach for bringing quality care to remote areas underserved by the formal health system.…”

Section: Discussionmentioning

confidence: 99%

Beyond ‘test and treat’ – malaria diagnosis for improved pediatric fever management in sub-Saharan Africa

Johansson

2016

Global Health Action

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BackgroundMalaria rapid diagnostic tests (RDTs) have great potential to improve quality care and rational drug use in malaria-endemic settings although studies have shown common RDT non-compliance. Yet, evidence has largely been derived from limited hospital settings in few countries. This article reviews a PhD thesis that analyzed national surveys from multiple sub-Saharan African countries to generate large-scale evidence of malaria diagnosis practices and its determinants across different contexts.DesignA mixed-methods approach was used across four studies that included quantitative analysis of national household and facility surveys conducted in multiple sub-Saharan African countries at the outset of new guidelines (Demographic and Health Surveys and Service Provision Assessments). Qualitative methods were used to explore reasons for quantitative findings in select settings.ResultsThere was low (17%) and inequitable test uptake across 13 countries in 2009–2011/12, with greater testing at hospitals than at peripheral clinics (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.56–0.69) or community health workers (OR: 0.31, 95% CI: 0.23–0.43) (Study I). Significant variation was found in the effect of diagnosis on antimalarial use at the population level across countries (Uganda OR: 0.84, 95% CI: 0.66–1.06; Mozambique OR: 3.54, 95% CI: 2.33–5.39) (Study II). A Malawi national facility census indicated common compliance to malaria treatment guidelines (85% clients with RDT-confirmed malaria prescribed first-line treatment), although other fever assessments were not often conducted and there was poor antibiotic targeting (59% clients inappropriately prescribed antibiotics). RDT-negative patients had 16.8 (95% CI: 8.6–32.7) times higher odds of antibiotic overtreatment than RDT-positive patients conditioned by cough or difficult breathing complaints (Study III). In Mbarara (Uganda), health workers reportedly prescribed antimalarials to RDT-negative patients if no other fever cause was identified and non-compliance seemed further driven by RDT perceptions, system constraints, and client interactions (Study IV).ConclusionsA shift from malaria-focused test and treat strategies toward IMCI with testing is needed to improve quality care and rational use of both antimalarial and antibiotic medicines. Strengthened health systems are also needed to support quality clinical care, including adherence to malaria test results, and RDT deployment should be viewed as a unique opportunity to contribute to these important efforts.

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“…Previous studies have only evaluated interventions in drug shops and have not assessed the impact of training other private providers to diagnose and treat malaria, pneumonia, and diarrhea beyond drug shops. [3][4][5][6][7][8] To improve treatment of sick children in the private health sector, we designed a study with the main objective of training providers to adhere to integrated community case management (iCCM) treatment guidelines in private health facilities. 9 We hypothesized that training private healthcare providers on appropriate treatment of common childhood illnesses and raising community awareness would lead to improved treatment and uptake of referral advice.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Sick Children Seeking Care in the Private Health Sector in Uganda: A Cluster Randomized Trial

Mbonye

Buregyeya

Rutebemberwa

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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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 (P = 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 (P = 0.04). Appropriate treatment of mRDT-positive children with artemisininbased 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 (P = 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 (P = 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 (P = 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.

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Drug seller adherence to clinical protocols with integrated management of malaria, pneumonia and diarrhoea at drug shops in Uganda

Cited by 39 publications

References 20 publications

Biomedical drugs and traditional treatment in care seeking pathways for adults with epilepsy in Masindi district, Western Uganda: a household survey

Biomedical drugs and traditional treatment in care seeking pathways for adults with epilepsy in Masindi district, Western Uganda: a household survey

Beyond ‘test and treat’ – malaria diagnosis for improved pediatric fever management in sub-Saharan Africa

Treatment of Sick Children Seeking Care in the Private Health Sector in Uganda: A Cluster Randomized Trial

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