Integrated community case management by drug sellers influences appropriate treatment of paediatric febrile illness in South Western Uganda: a quasi‑experimental study
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Malaria journal
Abstract
Fever case management is a major challenge for improved child health globally, despite existence of
cheap and effective child survival health technologies. The integrated Community Case Management (iCCM) intervention
of paediatric febrile illnesses though adopted by Uganda’s Ministry of Health to be implemented by community
health workers, has not addressed the inaccess to life-saving medicines and diagnostics. Therefore, the iCCM
intervention was implemented in private drug shops and evaluated for its effect on appropriate treatment of paediatric
fever in a low malaria transmission setting in South Western Uganda.
Methods: From June 2013 to September 2015, the effect of the iCCM intervention on drug seller paediatric fever
management and adherence to iCCM guidelines was assessed in a quasi-experimental study in South Western
Uganda. A total of 212 care-seeker exit interviews were done before and 285 after in the intervention arm as compared
to 216 before and 268 care-seeker interviews at the end of the study period in the comparison arm. The intervention
effect was assessed by difference-in-difference analysis of drug seller treatment practices against national
treatment recommendations between the intervention and comparison arms. Observed proportions among careseeker
interviews were compared with corresponding proportions from 5795 child visits recorded in patient registries
and 49 direct observations of drug seller–care-seeker encounters in intervention drug shops.
Results: The iCCM intervention increased the appropriate treatment of uncomplicated malaria, pneumonia symptoms
and non-bloody diarrhoea by 80.2% (95% CI 53.2–107.2), 65.5% (95% CI 51.6–79.4) and 31.4% (95% CI 1.6–61.2),
respectively. Within the intervention arm, drug seller scores on appropriate treatment for pneumonia symptoms and
diagnostic test use were the same among care-seeker exit interviews and direct observation. A linear trend (negative
slope, − 0.009 p value < 0.001) was observed for proportions of child cases prescribed any antimicrobial medicine
in the intervention arm drug shops.
Conclusions: The iCCM intervention improved appropriate treatment for uncomplicated malaria, pneumonia
symptoms and diarrhoea. Drug seller adherence to iCCM guidelines was high, without causing excessive prescription
of antimicrobial medicines in this study. Further research should assess whether this effect is sustained over time and
under routine supervision models.
Description
Keywords
Integrated case management, Drug sellers, Uganda, Febrile illness, Malaria, Pneumonia, Private sector, Diagnostics, Appropriate treatment
Citation
Kitutu, F. E., Kalyango, J. N., Mayora, C., Selling, K. E., Peterson, S., & Wamani, H. (2017). Integrated community case management by drug sellers influences appropriate treatment of paediatric febrile illness in South Western Uganda: a quasi-experimental study. Malaria journal, 16(1), 1-18. DOI 10.1186/s12936-017-2072-9