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- 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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| 2. |
- Bagonza, Arthur, et al.
(författare)
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'I know those people will be approachable and not mistreat us' : a qualitative study of inspectors and private drug sellers' views on peer supervision in rural Uganda
- 2020
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Ingår i: Globalization and Health. - : Springer Nature. - 1744-8603. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Peer supervision improves health care delivery by health workers. However, in rural Uganda, self-supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than 5 years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self-supervision currently practiced by drug sellers at district level in rural Uganda.METHODS: In this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with 130 drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management.RESULTS: A model with four dimensions defining an appropriate peer supervisor was developed. The dimensions included; incentives, clearly defined roles, mediation and role model peer supervisor. While all dimensions were regarded as being important, all participants interviewed agreed that incentives for peer supervisors were the most crucial. Overall, an appropriate peer supervisor was described as being exemplary to other drug sellers, operated within a defined framework, well facilitated to do their role and a good go-between drug sellers and government inspectors.CONCLUSION: Four central contributions advance literature by the model developed by our study. First, the model fills a supervision gap for rural private drug sellers. Second, it highlights the need for terms of reference for peer supervisors. Third, it describes who an appropriate peer supervisor should be. Lastly, it elucidates the kind of resources needed for peer supervision.
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| 4. |
- Bagonza, Arthur, et al.
(författare)
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Regulatory inspection of registered private drug shops in East-Central Uganda-what it is versus what it should be : a qualitative study
- 2020
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Ingår i: Journal of Pharmaceutical Policy and Practice. - : SPRINGERNATURE. - 2052-3211. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Regulatory inspection of private drug shops in Uganda is a mandate of the Ministry of Health carried out by the National Drug Authority. This study evaluated how this mandate is being carried out at national, district, and drug shop levels. Specifically, perspectives on how the inspection is done, who does it, and challenges faced were sought from inspectors and drug sellers. Methods Six key informant interviews (KIIs) were held with inspectors at the national and district level, while eight focus group discussions (FGDs) were conducted among nursing assistants, and two FGDs were held with nurses. The study appraised current methods of inspecting drug sellers against national professional guidelines for licensing and renewal of class C drug shops in Uganda. Transcripts were managed using Atlas ti version 7 (ATLAS.ti GmbH, Berlin) data management software where the thematic content analysis was done. Results Five themes emerged from the study: authoritarian inspection, delegated inspection, licensing, training, and bribes. Under authoritarian inspection, drug sellers decried the high handedness used by inspectors when found with expired or no license at all. For delegated inspection, drug sellers said that sometimes, inspectors send health assistants and sub-county chiefs for inspection visits. This cadre of people is not recognized by law as inspectors. Inspectors trained drug sellers on how to organize their drug shops better and how to use new technologies such as rapid diagnostic tests (RDTs) in diagnosing malaria. Bribes were talked about mostly by nursing assistants who purported that inspectors were not interested in inspection per se but collecting illicit payments from them. Inspectors said that the facilitation they received from the central government were inadequate for a routine inspection. Conclusion The current method of inspecting drug sellers is harsh and instills fear among drug sellers. There is a need to establish a well-recognized structure of inspection as well as establish channels of dialogue between inspectors and drug sellers if meaningful compliance is to be achieved. The government also needs to enhance both human and financial resources if meaningful inspection of drug sellers is to take place.
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| 5. |
- Mutto, Milton
(författare)
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Injuries among children and young adults in Uganda : epidemiology and prevention
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Injuries are a major morbidity and mortality cause among children and young adults worldwide. Previous Ugandan studies were limited in scope and biased towards severe adulthood injuries in referral care. Aims and Objectives: This study explored the epidemiology of childhood and young adulthood injuries in Uganda: specifically their extent, pattern, distribution, risk and determinants, and stakeholder perceptions their regarding prevention and control. Methods: Cross-sectional survey was used to describe unintentional domestic injury patterns and determinants among under-fives; facility-based surveillance, to determine the distribution, characteristics, and outcomes of violent injuries among 13-23-year-olds and all injuries among under-13s; cohort design, to explore the extent, nature and determinants of school-related risk; FGDs and KIIs, to explore stakeholder perceptions of prevention. Chi-square tests were used to evaluate categorical differences, t-tests, quantitative differences, odds ratios, associations, survival and multi-level modelling, time and contextual effects; and content and thematic analyses, stakeholder perceptions. Results: Home-, road-, school- and hospital-related childhood injuries are major but underreported. Violent injuries among youth constitute 7.3percent of total injuries, with a case fatality of 4percent. Fall and burn injuries are the greatest domestic injury risk among under-fives, while traffic, falls and sport injuries are commonest among school children. Travel, break-time activities and practical classes are most risky. Intentional injuries are skewed, peaking at 21 years; males double females‘ prevalence of victimisation. Students, casual labourers and housewives are most at risk. Teenager housewives have a higher victimisation risk. Blunt force, stabs/cuts, gunshots, and burns are the main injury mechanisms, with variations depending on location. Most prevalent intentional injuries are cuts/bites, open wounds and superficial injuries, majority are minor. The risk of home, school, and traffic injury is high, with age and contextual variations. The cumulative prevalence of school-related injury is 36.1percent, with a rate of 12.3/1000 person years. The case fatality rate of the non-intentional domestic childhood injuries is 1.1/100/year. The odds of domestic burns fall progressively from the first to the sixth year of life; after this, traffic and falls lead. At four, burn, fall and traffic injury odds approximate parity. Injury determinants include poor housing, poor supervision, and domestic energy type, school, HIV status, age and gender. The perceived drivers of injury spurts are staple food supply, social activities and competitive sports. Emergent explanations include childhood, parenting, and situational factors. Lack of guidance and counselling, hunger, intimate-partner violence (IPV), domestic violence, unsafe cooking and household chores, idleness, poor parental control, child maltreatment, corporal punishment, and unsafe storage of sharp objects are thought to cause injuries. Most stakeholders believe in prevention through education and environmental modification. Education, voluntary counselling and HIV testing and disclosure were recommended. Local treatments include sugar, cold water, bathroom sand, and urine for burn injuries; sticks, bandages, ropes, liniment and stretchers for fractures and dislocations; and raw eggs, cooking oil and milk for poisoning. Few NGOs work on injuries and violence in rural Uganda, yet injury care within the existing health facilities is not adequate. Conclusions: Childhood and young adulthood injuries are common in Ugandan homes, schools, and roads with age, sex, contextual differences. Injury risk is high across Uganda with travel, practical classes, break-time activities and gardening being most risky. The determinants include maternal and child age, house condition, supervision quality, gender, school and location. Linkages are thought to exist between staple food supply, major social events, and hunting seasons and injury risk. These factors interact with individual, parental, and situational factors to pattern childhood injuries in rural Uganda. Local management strategies exist, most of them based on traditional knowledge and beliefs that may require separate quantitative evaluation. Other proposed educational interventions are based on the ineffective ‘victim blame template‘.
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