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- Bagonza, Arthur, et al.
(författare)
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Peer supervision experiences of drug sellers in a rural district in East-Central Uganda : a qualitative study
- 2020
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Ingår i: Malaria Journal. - : Springer Nature. - 1475-2875. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Support supervision improves performance outcomes among health workers. However, the national professional guidelines for new licenses and renewal for Class C drug shops in Uganda prescribe self-supervision of licensed private drug sellers. Without support supervision, inappropriate treatment of malaria, pneumonia and diarrhoea among children under 5 years of age continues unabated. This study assessed experiences of drug sellers and peer supervisors at the end of a peer supervision intervention in Luuka District in East Central Uganda. Methods Eight in-depth interviews (IDIs) were held with peer supervisors while five focus group discussions (FGDs) were conducted among registered drug sellers at the end of the peer supervision intervention. The study assessed experiences and challenges of peer supervisors and drug sellers regarding peer supervision. Transcripts were imported into Atlas.ti 7 qualitative data management software where they were analysed using thematic content analysis. Results Initially, peer supervisors were disliked and regarded by drug sellers as another extension of drug inspectors. However, with time a good relationship was established between drug sellers and peer supervisors leading to regular, predictable and supportive peer supervision. This increased confidence of drug sellers in using respiratory timers and rapid diagnostic tests in diagnosing pneumonia symptoms and uncomplicated malaria, respectively, among children under 5 years. There was also an improvement in completing the sick child register which was used for self-assessment by drug sellers. The drug shop association was mentioned as a place where peer supervision should be anchored since it was a one-stop centre for sharing experiences and continuous professional development. Drug sellers proposed including community health workers in monthly drug shop association meetings so that they may also gain from the associated benefits. Untimely completion of the sick child registers by drug sellers and inadequate financial resources were the main peer supervision challenges mentioned. Conclusion Drug sellers benefitted from peer supervision by developing a good relationship with peer supervisors. This relationship guaranteed reliable and predictable supervision ultimately leading to improved treatment practices. There is need to explore the minimum resources needed for peer supervision of drug sellers to further inform practice and policy.
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| 2. |
- Bagonza, Arthur, et al.
(författare)
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Effectiveness of peer-supervision on pediatric fever illness treatment among registered private drug sellers in East-Central Uganda : An interrupted time series analysis
- 2021
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Ingår i: Health Science Reports. - : John Wiley & Sons. - 2398-8835. ; 4:2
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Tidskriftsartikel (refereegranskat)abstract
- Rationale aims and objectives: Appropriate treatment of pediatric fever in rural areas remains a challenge and maybe partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer-supervision among drug sellers on the appropriate treatment of pneumonia symptoms, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age in the intervention (Luuka) and comparison (Buyende) districts, in East-Central Uganda.Methods: Data on pneumonia symptoms, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age was abstracted from drug shop sick child registers over a 12-month period; 6 months before and 6 months after the introduction of peer-supervision. Interrupted time series were applied to determine the effectiveness of the peer-supervision intervention on the appropriate treatment of pneumonia, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age attending drug shops in East Central Uganda.Results: The proportion of children treated appropriately for pneumonia symptoms was 10.84% (P < .05, CI = [1.75, 19.9]) higher, for uncomplicated malaria was 1.46% (P = .79, CI = [-10.43, 13.36]) higher, and for non-bloody diarrhea was 4.00% (P < .05, CI = [-7.95, -0.13]) lower in the intervention district than the comparison district, respectively.Post-intervention trend results showed an increase of 1.21% (P = .008, CI = [0.36, 2.05]) in the proportion appropriately treated for pneumonia symptoms, no difference in appropriate treatment for uncomplicated malaria, and a reduction of 1% (P < .06, CI = [-1.95, 0.02]) in the proportion of children appropriately treated for non-bloody diarrhea, respectively.Conclusions: Peer-supervision increased the proportion of children less than 5 years of age that received appropriate treatment for pneumonia symptoms but not for uncomplicated malaria and non-bloody diarrhea. Implementation of community-level interventions to improve pediatric fever management should consider including peer-supervision among drug sellers.
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| 3. |
- Mukanga, David, et al.
(författare)
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Access, acceptability and utilization of community health workers using diagnostics for case management of fever in Ugandan children : a cross-sectional study
- 2012
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Ingår i: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 11, s. 121-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Use of diagnostics in integrated community case management (iCCM) of fever is recognized as an important step in improving rational use of drugs and quality of care for febrile under-five children. This study assessed household access, acceptability and utilization of community health workers (CHWs) trained and provided with malaria rapid diagnostic tests (RDTs) and respiratory rate timers (RRTs) to practice iCCM. Methods: A total of 423 households with under-five children were enrolled into the study in Iganga district, Uganda. Households were selected from seven villages in Namungalwe sub-county using probability proportionate to size sampling. A semi-structured questionnaire was administered to caregivers in selected households. Data were entered into Epidata statistical software, and analysed using SPSS Statistics 17.0, and STATA version 10. Results: Most (86%, 365/423) households resided within a kilometre of a CHW's home, compared to 26% (111/423) residing within 1 km of a health facility (p<0.001). The median walking time by caregivers to a CHW was 10 minutes (IQR 5-20). The first option for care for febrile children in the month preceding the survey was CHWs (40%, 242/601), followed by drug shops (33%, 196/601). Fifty-seven percent (243/423) of caregivers took their febrile children to a CHW at least once in the three month period preceding the survey. Households located 1-3 km from a health facility were 72% (AOR 1.72; 95% CI 1.11-2.68) more likely to utilize CHW services compared to households within 1 km of a health facility. Households located 1-3 km from a CHW were 81% (AOR 0.19; 95% CI 0.10-0.36) less likely to utilize CHW services compared to those households residing within 1 km of a CHW. A majority (79%, 336/423) of respondents thought CHWs services were better with RDTs, and 89% (375/423) approved CHWs' continued use of RDTs. Eighty-six percent (209/243) of respondents who visited a CHW thought RRTs were useful. Conclusion: ICCM with diagnostics is acceptable, increases access, and is the first choice for caregivers of febrile children. More than half of caregivers of febrile children utilized CHW services over a three-month period. However, one-third of caregivers used drug shops in spite of the presence of CHWs.
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| 4. |
- Mukanga, David Odaka
(författare)
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Community case management of malaria and pneumonia in children : exploring use of diagnostics by community health workers in Uganda
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Malaria and pneumonia are leading causes of under-five mortality in Sub-Saharan Africa. WHO/UNICEF recommend integrated community malaria and pneumonia care in situations where febrile children also have cough and rapid breathing. Presumptive treatment of all fevers as malaria leads to excessive use of anti-malarial drugs and delays the recognition and treatment of non-malaria fevers. Using malaria rapid diagnostic tests (RDTs) and respiratory rate counting could be a potential solution. Main aim: To assess community acceptability and utilisation, provider competence, and the effectiveness of diagnostic-based integrated community case management of malaria and pneumonia in children in order to inform implementation. Methods: Four studies (I-IV) were conducted in Iganga district, Uganda with data for Study IV collected at two additional sites in Burkina Faso and Ghana. In Study I, 10 key informant interviews with health workers and community leaders, and 10 focus group discussions with CHWs and caregivers were done. Study II was a prospective case series with 182 child observations. Study III was a cross-sectional study with 423 caregivers of under-fives. Study IV was a cluster randomised controlled trial (cRCT) with 4,216 under-fives. Content analysis was used for qualitative data. Quantitative data was analysed at uni-, bi- and multivariate levels, while analysis of Study IV was by intention to treat. Results: From the cRCT, the odds of having fever on day 3 was 41% lower in the intervention arm compared to the control arm (OR 0.59, 95% CI 0.38, 0.93; p=0.02). Community acceptability of use of RDTs by CHWs was high (89%; 375/423) (III). Some community members had fears about drawing blood (I), but reports of these were few in Study III (4/423). Most (86%, 365/423) households resided within 1 km of a CHW, compared to 26% (111/423) residing within 1 km of a health facility (p<0.001). CHWs were the first option for care of febrile children (40%, 242/601), and 3-month utilisation was 57% (243/423). CHWs’ performance was adequate in taking history, using timers and RDTs, but inadequate in classification of illness. Breath readings (classified as fast or normal) were 85% in agreement with the paediatrician (ĸ = 0.665, p < 0.001) with a sensitivity and specificity of 81% and 87% respectively (II). In the cRCT, there was good compliance with RDT results in the intervention arm with most (1739/1740) RDT positive children prescribed an anti-malarial, and only 4.9% (17/344) of RDT negative children prescribed an anti-malarial drug. Among children with a high respiratory rate, antibiotics were administered to 86.5% (198/229) in Burkina Faso, 72.5% (103/142) in Ghana, and 98.3% (520/529) in Uganda. Antibiotic overuse was 0.9% (4/446) in Uganda, 38.5% (114/296) in Burkina Faso, and 44.6% (197/442) in Ghana. Conclusion: Diagnostic-based iCCM improves fever clearance in febrile children compared to presumptive treatment of malaria. RDTs and ARI timers should be introduced into iCCM programmes. CHWs used the two diagnostics to distinguish and treat both malaria and pneumonia; the strategy improves access to treatment for both conditions among under-fives; and communities welcomed the diagnostic-based strategy. While CHW compliance with RDT results was high, compliance to respiratory rate results for pneumonia was lower. Programmes should plan for adequate resources to support CHWs with supplies, logistics and supervision for quality iCCM.
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