Abstract
IntroductionDrug shops are a major source of care for children in low income countries but they provide sub-standard care. We assessed the feasibility and effect on quality of care of introducing diagnostics and pre-packaged paediatric-dosage drugs for malaria, pneumonia and diarrhoea at drug shops in Uganda.MethodsWe adopted and implemented the integrated community case management (iCCM) intervention within registered drug shops. Attendants were trained to perform malaria rapid diagnostic tests (RDTs) in each fever case and count respiratory rate in each case of cough with fast/difficult breathing, before dispensing recommended treatment. Using a quasi-experimental design in one intervention and one non-intervention district, we conducted before and after exit interviews for drug seller practices and household surveys for treatment-seeking practices in May–June 2011 and May–June 2012. Survey adjusted generalized linear models and difference-in-difference analysis was used.Results3759 (1604 before/2155 after) household interviews and 943 (163 before/780 after) exit interviews were conducted with caretakers of children under-5. At baseline, no child at a drug shop received any diagnostic testing before treatment in both districts. After the intervention, while no child in the non-intervention district received a diagnostic test, 87.7% (95% CI 79.0–96.4) of children with fever at the intervention district drug shops had a parasitological diagnosis of malaria, prior to treatment. The prevalence ratios of the effect of the intervention on treatment of cough and fast breathing with amoxicillin and diarrhoea with ORS/zinc at the drug shop were 2.8 (2.0–3.9), and 12.8 (4.2–38.6) respectively. From the household survey, the prevalence ratio of the intervention effect on use of RDTs was 3.2 (1.9–5.4); Artemisinin Combination Therapy for malaria was 0.74 (0.65–0.84), and ORS/zinc for diarrhoea was 2.3 (1.2–4.7).ConclusioniCCM can be utilized to improve access and appropriateness of care for children at drug shops.
Highlights
Drug shops are a major source of care for children in low income countries but they provide sub-standard care
Following on from lessons learned in the public sector roll out of Integrated Management of Childhood Illness (IMCI) [2, 3], the integrated Community Case Management of malaria, pneumonia and diarrhoea targets the community level for integration of diagnostics with pre-packaged drugs for these illnesses. integrated community case management (iCCM) is being scaled up through the efforts of UNICEF, WHO and several large donors. [4]
[14] These districts were chosen because they had both participated in a previous study, the Consortium for ACT Private Sector Subsidy (CAPSS) pilot study where ACTs for malaria had been made available in registered drug shops. [15]
Summary
Drug shops are a major source of care for children in low income countries but they provide sub-standard care. We assessed the feasibility and effect on quality of care of introducing diagnostics and pre-packaged paediatricdosage drugs for malaria, pneumonia and diarrhoea at drug shops in Uganda. While no child in the non-intervention district received a diagnostic test, 87.7% (95% CI 79.0–96.4) of children with fever at the PLOS ONE | DOI:10.1371/journal.pone.0115440. Following on from lessons learned in the public sector roll out of Integrated Management of Childhood Illness (IMCI) [2, 3], the integrated Community Case Management (iCCM) of malaria, pneumonia and diarrhoea targets the community level for integration of diagnostics with pre-packaged drugs for these illnesses. [12]The challenge now is to integrate both diagnostics, and alternative appropriate treatment, [13] in order to simultaneously achieve rational use of drugs for both antimalarials and antibiotics, at the same time as good quality of care for the febrile child, irrespective of cause of fever WHO recommends parasitological diagnosis of malaria for all patients, including children less than 5 years, prior to treatment. [12]The challenge now is to integrate both diagnostics, and alternative appropriate treatment, [13] in order to simultaneously achieve rational use of drugs for both antimalarials and antibiotics, at the same time as good quality of care for the febrile child, irrespective of cause of fever
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
