Effectiveness of educational outreach in infectious diseases management: a cluster randomized trial in Uganda
Loading...
Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Public Health
Abstract
Integrated Infectious Diseases Capacity Building Evaluation (IDCAP) teams designed and implemented
two health worker in-service training approaches: 1) an off-site classroom-based integrated management of
infectious diseases (IMID) course with distance learning aspects, and 2) on-site support (OSS), an educational
outreach intervention. We tested the effects of OSS on workload and 12 facility performance indicators for
emergency triage assessment and treatment, HIV testing, and malaria and pneumonia case management
among outpatients by two subgroups: 1) mid-level practitioners (MLP) who attended IMID training (IMID-MLP)
and 2) health workers who did not (No-IMID).
Methods: Thirty-six health facilities participated in the IDCAP trial, with 18 randomly assigned to Arm A and
18 to Arm B. Two MLP in both arms received IMID. All providers at Arm A facilities received nine monthly OSS visits
from April to December 2010 while Arm B did not. From November 2009 to December 2010, 777,667 outpatient visits
occurred. We analyzed 669,580 (86.1 %) outpatient visits, where provider cadre was reported. Treatment was provided
by 64 IMID-MLP and 1,515 No-IMID providers. The effect of OSS was measured by the difference in pre/post changes
across arms after controlling for covariates (adjusted ratio of relative risks = aRRR).
Results: The effect of OSS on patients-per-provider-per-day (workload) among IMID-MLP (aRRR = 1.21; p = 0.48) and
No-IMID (aRRR = 0.90; p = 0.44) was not statistically significant. Among IMID-MLP, OSS was effective for three indicators:
malaria cases receiving an appropriate antimalarial (aRRR = 1.26, 99 % CI = 1.02-1.56), patients with negative malaria test
result prescribed an antimalarial (aRRR = 0.49, 99 % CI = 0.26-0.92), and patients with acid-fast bacilli smear negative
result receiving empiric treatment for acute respiratory infection (aRRR = 2.04, 99 % CI = 1.06-3.94). Among No-IMID,
OSS was effective for two indicators: emergency and priority patients admitted, detained or referred (aRRR = 2.12,
99 % CI = 1.05-4.28) and emergency patients receiving at least one appropriate treatment (aRRR = 1.98, 99 % CI = 1.21-3.24).
Conclusion: Effects of OSS on workload were not statistically significant. Significant OSS effects on facility performance
across subgroups were heterogeneous. OSS supported MLP who diagnosed and treated patients to apply IMID
knowledge. For other providers, OSS supported team work to manage emergency patients. This evidence on OSS
effectiveness could inform interventions to improve health workers’ capacity to deliver better quality infectious diseases
care.
Description
Keywords
Educational outreach, Classroom training, Mid-level health providers
Citation
Mbonye, M. K., Burnett, S. M., Naikoba, S., Ronald, A., Colebunders, R., Van Geertruyden, J. P., & Weaver, M. R. (2016). Effectiveness of educational outreach in infectious diseases management: a cluster randomized trial in Uganda. BMC Public Health, 16(1), 1-14. DOI 10.1186/s12889-016-3375-4