Management of Childhood Infections in Poorly Planned Urban Settlements in Kampala and Wakiso Districts of Uganda

Abstract

. The main objective of this study was to assess the management of childhood infections in high-density poorly planned urban areas of Kampala and Wakiso districts in Uganda, to develop a strategy to deliver integrated community case management (iCCM) of childhood illness services. A total of 72 private healthcare facilities were surveyed (36 drug shops, eight pharmacies, 27 private clinics, and one herbal clinic); supplemented by focus group discussions with village health teams (VHTs), drug shops, and private clinic providers. The majority of drug shops (96.4%, 27/28), pharmacies (100%, 8/8), and (68%, private clinics 17/27) were registered; however, supervision was poor. The majority of patients (> 77%) who visited private health facilities were children aged < 5 years. Furthermore, over 80% (29/64) of the children with uncomplicated malaria were reported to have been given artemether–lumefantrine, and 42% with difficulty breathing were given an antibiotic. Although > 72% providers said they referred children with severe illnesses, taking up referral was complicated by poverty, long distances, and the perception that there were inadequate drugs at referral facilities. Less than 38% of all the facilities had malaria treatment guidelines; < 15% had iCCM guidelines; 6% of the drug shops had iCCM guidelines; and < 13% of the facilities had pneumonia and diarrhea treatment guidelines. Village health teams existed in the study areas, although they had little knowledge on causes and prevention of pneumonia. In conclusion, this study found that quality of care was poor and introduction of iCCM delivered through VHTs, drug shops, and private clinics may, with proper training and support, be a feasible intervention to improve care.

“Testing for malaria does not cure any pain” A qualitative study exploring low use of malaria rapid diagnostic tests at drug shops in rural Uganda

“…Private drug shops in Uganda are commonly the first point of care for fever and an important source of essential medications such as antimalarials [5,6]. Despite their popularity, many drug shops are unlicensed or operated by vendors who lack the qualifications required by the National Drug Authority [7][8][9]. Drug shop vendors do not always have formal training in malaria case management [10] or provide treatment in accordance with national guidelines [5,7,[9][10][11][12].…”

“…Despite their popularity, many drug shops are unlicensed or operated by vendors who lack the qualifications required by the National Drug Authority [7][8][9]. Drug shop vendors do not always have formal training in malaria case management [10] or provide treatment in accordance with national guidelines [5,7,[9][10][11][12]. Perhaps most critically, not all clients receiving antimalarials from drug shops have a confirmed malaria diagnosis.…”

Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda

“…This therefore necessitates supportive supervision or a closer follow up by the policy implementation team at the district. The LLPHF are often left out in refresher training and in addition often do not have access to current treatment guidelines [15,[50][51][52]. The fact that young infants with possible serious bacterial infections were wrongly diagnosed and consequently inappropriately treated could be explained by the limited knowledge of diseases affecting young infants, an area needing specialists, yet the health workers at LLPHF are mostly of a lower cadre.…”

Key Considerations for RCCE in the 2022 Ebola Outbreak Response in Greater Kampala, Uganda

“…That said, there is a general preference among the public in Kampala for private over public health services, as private services are usually much easier to access due to closer proximity, quick attention and financial flexibility. 10 Government health facilities, which also charge user fees, have long wait times and may lack medicine stocks (or be expected to).…”

“…There can be improved engagement between the public sector health system and private facilities and services, 10,19 as private clinic providers and pharmacists or drug shops are often less engaged in outbreak response during emergencies. However, private providers, which also include faith and traditional healers, may be consulted by people seeking treatment or advice for symptoms that could indicate SVD.…”