effectiveness of introducing integrated case management of...
TRANSCRIPT
Improved Treatment of Childhood Illnesses with Integrated Management of Malaria,
Pneumonia and Diarrhoea at Drug Shops in Uganda
Dr. Phyllis Awor Email: [email protected]
Stakeholders’ consultation on informal health care providers/Chennai, India March 21-22 2014
Introduction
iCCM Tool kit
• 2002 – 2009 Home Based Management of Fever strategy
• 2010 iCCM policy
• Scale up throughCHWs across Africa in public sector
• No similar private sector intervention
Integrated Community Case Management of Malaria, Pneumonia and Diarrhoea (iCCM)
Problem Statement
Drug shops are an important source of care for
children – 60% febrile children in Uganda
treated by private sector - drug shops yet:
– Largely unregulated
– Quality of care is poor
– Drug use irrational
Objective
Determine feasibility and effectiveness of diagnostics and pre-packed drugs for malaria, pneumonia and diarrhoea in registered drug shops in Eastern Uganda
Methods Quasi Experimental Design
Intervention district: N = 44 drug shops
iCCM
1. Subsidized pre-packed drugs
2. Free Diagnostics
3. Training
4. Social Marketing
Comparison district:
N = 40 drug shops
Standard AMFm
1. Presumptive treatment of fever with ACT
Methods • 10 months duration (10/2011 – 07/2012)
• Baseline - Endline Assessments
Exit interviews at drug shops – treatment practices
Review of treatment registers – Adherence to protocols (Intervention)
• Analysis
Appropriate management (proportions)
Fever management at Drug Shop –Exit Interviews
0 0
83.6
0 0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nta
ge
Diagnosis using RDT prior to treatment
Baseline 8 months
Control
0 0
76
5 0
10
20
30
40
50
60
70
80
90
Pe
rce
nta
ge
Treatment of Diarrhoea
0 0
55
0 0
10
20
30
40
50
60
70
80
Pe
rce
nta
ge
Management of cough+ fast breathing using respiratory timer
and amoxicillin
Correct Management at drug shops – Exit Interviews
Control
Baseline 8 Months Baseline 8 Months
Fever Management from Register Records (N = 7667)
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
All visits fever RDT RDT positive RDT positive + ACT
Management of Fever
Number of children
Pneumonia management - from Register records
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
All vists reported cough+fast breathing
respiratory rate assessed
diagnosis fast breathing
received amoxicillin
Management of Pneumonia
Number of Children
Diarrhoea management from Register records
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
All visits diarrhoea diarrhoea & ORS/Zinc
Management of diarrhoea
Number of children
Care seeking – Household Survey
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline (N=800) 8 Months (N=1086)
20.1 20.7
29.8
55.5
First Point of Care for Febrile Child - Intervention District
Other
Drug shop
Other private sector
Health Centre
Managed at home
Health Ctr
Conclusions
• Expanded access to diagnostics and quality treatment at drug shops with iCCM
• High adherence to treatment protocols by drug sellers
• iCCM may be utilized to mainstream drug shops in pluralistic health systems
Acknowledgements
• Einhorn Family Foundation –Sweden
• Medicines for Malaria Venture
• Caretakers and children in study area
• Research team