Integrated community case management by drug sellers influences appropriate treatment of paediatric febrile illness in South Western Uganda: a quasi-experimental study

• Published in: Malaria journal 2017-10, Vol.16 (1), p.425-425, Article 425
• Main Authors: Kitutu, Freddy Eric, Kalyango, Joan Nakayaga, Mayora, Chrispus, Selling, Katarina Ekholm, Peterson, Stefan, Wamani, Henry
• Format: Article
• Language: English
• Subjects: Antidiarrheals - administration & dosage; Antimalarials - administration & dosage; Appropriate treatment; Case management; Case Management - statistics & numerical data; Child, Preschool; Childhood fever; Community health services; Community Health Workers - statistics & numerical data; Diagnostics; Diarrhea; Diarrhea - drug therapy; Disease transmission; Drug sellers; Drug therapy; Drugs; Febrile illness; Fever; Guidelines; Health facilities; Human diseases; Humans; Infant; Informal economy; Integrated case management; Intervention; Malaria; Malaria - drug therapy; Management; Medical case management; Medical personnel; Medical sciences; Medicin och hälsovetenskap; Medicine; Pneumonia; Pneumonia - drug therapy; Private sector; Quasi-experimental methods; Rural areas; Social aspects; Stakeholders; Survival; Symptoms; Uganda; Vector-borne diseases
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-017-2072-9

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. 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 care-seeker 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. 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