Abstract
BackgroundDrug shops are usually the first source of care for febrile children in Uganda although the quality of care they provide is known to be poor. Within a larger quasi-experimental study introducing the WHO/UNICEF recommended integrated community case management (iCCM) of malaria, pneumonia and diarrhoea intervention for community health workers in registered drug shops, the level of adherence to clinical protocols by drug sellers was determined.MethodsAll drug shops (N = 44) in the intervention area were included and all child visits (N = 7,667) from October 2011–June 2012 to the participating drug shops were analysed. Drug shops maintained a standard iCCM register where they recorded the children seen, their symptoms, diagnostic test performed, treatments given and actions taken. The proportion of children correctly assessed and treated was determined from the registers.ResultsMalaria management: 6,140 of 7,667 (80.1%) total visits to drug shops were of children with fever. 5986 (97.5%) children with fever received a malaria rapid diagnostic test (RDT) and the RDT positivity rate was 78% (95% CI 77–79). 4,961/5,307 (93.4%) children with a positive RDT received artemisinin combination therapy. Pneumonia management: after respiratory rate assessment of children with cough and fast/difficult breathing, 3,437 (44.8%) were categorized as “pneumonia”, 3,126 (91.0%) of whom received the recommended drug—amoxicillin. Diarrhoea management: 2,335 (30.5%) child visits were for diarrhoea with 2,068 (88.6%) correctly treated with oral rehydration salts and zinc sulphate. Dual/Triple classification: 2,387 (31.1%) children had both malaria and pneumonia and 664 (8.7%) were classified as having three illnesses. Over 90% of the children with dual or triple classification were treated appropriately. Meanwhile, 381 children were categorized as severely sick (with a danger sign) with 309 (81.1%) of them referred for appropriate management.ConclusionWith the introduction of the iCCM intervention at drug shops in Eastern Uganda, it was possible to achieve high adherence to the treatment protocols, which is likely compatible with increased quality of care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0798-9) contains supplementary material, which is available to authorized users.
Highlights
Drug shops are usually the first source of care for febrile children in Uganda the quality of care they provide is known to be poor
Every year, over 30 million cases of malaria, pneumonia and diarrhoea in children go untreated in Uganda [1]
The objective of this study was to determine the level of adherence by drug shop attendants in eastern Uganda, to the integrated community case management of malaria, pneumonia and diarrhoea treatment guidelines
Summary
Drug shops are usually the first source of care for febrile children in Uganda the quality of care they provide is known to be poor. Within a larger quasi-experimental study introducing the WHO/UNICEF recommended integrated community case management (iCCM) of malaria, pneumonia and diarrhoea intervention for community health workers in registered drug shops, the level of adherence to clinical protocols by drug sellers was determined. More than half of sick children in Uganda seek care at the level of a drug shop when ill [4, 5]. Evidence shows that health workers, both public and private generally have low adherence to clinical protocols. The adherence of drug shop attendants to treatment protocols for malaria, pneumonia and diarrhoea is largely unknown. Given the role of drug shops in the care for children in Uganda and other low-income countries, it is necessary to understand adherence to treatment protocols in this group of health providers
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