Private Sector Drug Shops in Integrated Community Case Management of Malaria, Pneumonia, and Diarrhea in Children in Uganda

Awor, Phyllis; Wamani, Henry; Bwire, Godfrey; Jagoe, George; Peterson, Stefan

doi:10.4269/ajtmh.2012.11-0791

Cited by 74 publications

(85 citation statements)

References 16 publications

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“…Similarly, few children with diarrhea received oral rehydration salts, and none received zinc tablets. The study concluded that management of common childhood illness at private sector drug shops in rural Uganda was largely inappropriate [30]. …”

Section: Discussionmentioning

confidence: 99%

Treatment of fevers prior to introducing rapid diagnostic tests for malaria in registered drug shops in Uganda

Mbonye

Lal

Cundill

et al. 2013

Malar J

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BackgroundSince drug shops play an important role in treatment of fever, introducing rapid diagnostic tests (RDTs) for malaria at drug shops may have the potential of targeting anti-malarial drugs to those with malaria parasites and improve rational drug use. As part of a cluster randomized trial to examine impact on appropriate treatment of malaria in drug shops in Uganda and adherence to current malaria treatment policy guidelines, a survey was conducted to estimate baseline prevalence of, and factors associated with, appropriate treatment of malaria to enable effective design and implementation of the cluster randomized trial.MethodsA survey was conducted within 20 geographical clusters of drug shops from May to September 2010 in Mukono district, central Uganda. A cluster was defined as a parish representing a cluster of drug shops. Data was collected using two structured questionnaires: a provider questionnaire to capture data on drug shops (n=65) including provider characteristics, knowledge on treatment of malaria, previous training received, type of drugs stocked, reported drug sales, and record keeping practices; and a patient questionnaire to capture data from febrile patients (n=540) exiting drug shops on presenting symptoms, the consultation process, treatment received, and malaria diagnoses. Malaria diagnosis made by drug shop vendors were confirmed by the study team through microscopy examination of a blood slide to ascertain whether appropriate treatment was received.ResultsAmong febrile patients seen at drug shops, 35% had a positive RDT result and 27% had a positive blood slide. Many patients (55%) had previously sought care from another drug shop prior to this consultation. Three quarters (73%) of all febrile patients seen at drug shops received an anti-malarial, of whom 39% received an ACT and 33% received quinine. The rest received another non-artemisinin monotherapy. Only one third (32%) of patients with a positive blood slide had received treatment with Coartem® while 34% of those with a negative blood slide had not received an anti-malarial. Overall appropriate treatment was 34 (95% CI: 28 – 40) with substantial between-cluster variation, ranging from 1% to 55%.ConclusionIn this setting, the proportion of malaria patients receiving appropriate ACT treatment at drug shops was low. This was due to the practice of presumptive treatment, inadequate training on malaria management and lack of knowledge that Coartem® was the recommended first-line treatment for malaria. There is urgent need for interventions to improve treatment of malaria at these outlets.

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Section: Discussionmentioning

confidence: 99%

Treatment of fevers prior to introducing rapid diagnostic tests for malaria in registered drug shops in Uganda

Mbonye

Lal

Cundill

et al. 2013

Malar J

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“…The study concluded that management of common childhood illnesses at private sector drug shops in rural Uganda was largely inappropriate. 3 Yet, it has been shown that approximately 48% of people with illnesses in Uganda seek care from private clinics, drug shops, and pharmacies as the first resort. 3 Given this scenario, we conceptualized that training providers in this sector might improve case management of the three major childhood illnesses (malaria, pneumonia, and diarrhea).…”

Section: Introductionmentioning

confidence: 99%

“…3 Yet, it has been shown that approximately 48% of people with illnesses in Uganda seek care from private clinics, drug shops, and pharmacies as the first resort. 3 Given this scenario, we conceptualized that training providers in this sector might improve case management of the three major childhood illnesses (malaria, pneumonia, and diarrhea). 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.…”

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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“…Almost 60 % of parents with febrile children in Uganda first seek care in the private sector, especially at drug shops [2], however they provide sub-standard care [3, 4]. A functioning referral system is a critical part of an appropriate health care delivery system [5].…”

Section: Introductionmentioning

confidence: 99%

Strengthening referral of sick children from the private health sector and its impact on referral uptake in Uganda: a cluster randomized controlled trial protocol

Buregyeya

Rutebemberwa

LaRussa

et al. 2016

BMC Health Serv Res

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BackgroundUganda’s under-five mortality is high, currently estimated at 66/1000 live births. Poor referral of sick children that seek care from the private sector is one of the contributory factors. The proposed intervention aims to improve referral and uptake of referral advice for children that seek care from private facilities (registered drug shops/private clinics).Methods/DesignA cluster randomized design will be applied to test the intervention in Mukono District, central Uganda. A sample of study clusters will implement the intervention. The intervention will consist of three components: i) raising awareness in the community: village health teams will discuss the importance of referral and encourage households to save money, ii) training and supervision of providers in the private sector to diagnose, treat and refer sick children, iii) regular meetings between the public and private providers (convened by the district health team) to discuss the referral system. Twenty clusters will be included in the study, randomized in the ratio of 1:1. A minimum of 319 sick children per cluster and the total number of sick children to be recruited from all clusters will be 8910; adjusting for a 10 % loss to follow up and possible withdrawal of private outlets.DiscussionThe immediate sustainable impact will be appropriate treatment of sick children. The intervention is likely to impact on private sector practices since the scope of the services they provide will have expanded. The proposed study is also likely to have an impact on families as; i) they may appreciate the importance of timely referral on child illness management, ii) the cost savings related to reduced morbidity will be used by household to access other social services. The linkage between the private and public sectors will create a potential avenue for delivery of other public health interventions and improved working relations in the two sectors. Further, improved quality of services in the private sector will improve provider confidence and hopefully more clientelle to the private practices.Trial registration NCT02450630 Registration date: May/9th/2015

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Private Sector Drug Shops in Integrated Community Case Management of Malaria, Pneumonia, and Diarrhea in Children in Uganda

Cited by 74 publications

References 16 publications

Treatment of fevers prior to introducing rapid diagnostic tests for malaria in registered drug shops in Uganda

Treatment of fevers prior to introducing rapid diagnostic tests for malaria in registered drug shops in Uganda

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

Strengthening referral of sick children from the private health sector and its impact on referral uptake in Uganda: a cluster randomized controlled trial protocol

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