Effectiveness of Introducing Integrated Case Management of...
Transcript of Effectiveness of Introducing Integrated Case Management of...
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