What influences availability of medicines for the community management of childhood illnesses in central Uganda? Implications for scaling up the integrated community case management programme.

James Bagonza,Elizeus Rutebemberwa,Tim Eckmanns,Elizabeth Ekirapa-Kiracho

doi:10.1186/s12889-015-2525-4

Abstract

BackgroundThe integrated Community Case Management (iCCM) of childhood illnesses strategy has been adopted world over to reduce child related ill health and mortality. Community Health workers (CHWs) who implement this strategy need a regular supply of drugs to effectively treat children under 5 years with malaria, pneumonia and diarrhea. In this paper, we report the prevalence and factors influencing availability of medicines for managing malaria, pneumonia and diarrhea in communities in central Uganda.MethodsA cross sectional study was conducted among 303 CHWs in Wakiso district in central Uganda. Eligible CHWs from two randomly selected Health Sub Districts (HSDs) were interviewed. Questionnaires, check lists, record reviews were used to collect information on CHW background characteristics, CHW’s prescription behaviors, health system support factors and availability of iCCM drugs. Multivariable logistic regression analysis was done to assess factors associated with availability of iCCM drugs.ResultsOut of 300 CHWs, 239 (79.9 %) were females and mean age was 42.1 (standard deviation =11.1 years). The prevalence of iCCM drug availability was 8.3 % and 33 respondents (11 %) had no drugs at all. Factors associated with iCCM drug availability were; being supervised within the last month (adjusted OR = 3.70, 95 % CI 1.22–11.24), appropriate drug prescriptions (adjusted OR = 3.71, 95 % CI 1.38–9.96), regular submission of drug reports (adjusted OR = 4.02, 95 % CI 1.62–10.10) and having a respiratory timer as a diagnostic tool (adjusted OR =3.11, 95 % CI 1.08–9.00).ConclusionsThe low medicine stocks for the community management of childhood illnesses calls for strengthening of CHW supervision, medicine prescription and reporting, and increasing availability of functional diagnostic tools.

Highlights

The integrated Community Case Management of childhood illnesses strategy has been adopted world over to reduce child related ill health and mortality
Three quarters of the under five deaths are still due to a handful of causes such as malaria, pneumonia, diarrhea and newborn conditions [5, 6]
Under the integrated Community Case Management (iCCM) strategy, Community Health Workers (CHWs) are trained to diagnose and treat sick children with malaria, pneumonia and diarrhea in communities. They are provided with pre-packed medicines which include amoxicillin for treating non severe pneumonia, Artemisinin Combination Therapy (ACT) for uncomplicated malaria, Oral Rehydration Salts (ORS) and zinc for diarrhea

Summary

Introduction

The integrated Community Case Management (iCCM) of childhood illnesses strategy has been adopted world over to reduce child related ill health and mortality. The integrated Community Case Management (iCCM) of common childhood illnesses (malaria, pneumonia and diarrhea) has been widely adopted as a means to reduce childhood morbidity and mortality by increasing access to essential child health services [7, 8]. Under the iCCM strategy, Community Health Workers (CHWs) are trained to diagnose and treat sick children with malaria, pneumonia and diarrhea in communities. All patients are screened for the three diseases and treatment is administered basing on the results of the examination and diagnostic testing that includes: malaria rapid diagnostic tests, disease history and respiratory rates This approach can result in a 70 % reduction in mortality from pneumonia in children under age five, and reduce overall malaria mortality by 53 % [9, 10]. Effective community case management calls for an uninterrupted supply of medicines and equipment necessary to promote early identification and correct treatment of childhood diseases [11,12,13]

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