Improved Treatment of Childhood Illnesses with Integrated Management of Malaria,

Pneumonia and Diarrhoea at Drug Shops in Uganda

Dr. Phyllis Awor Email: pawor@musph.ac.ug

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