Integrated community case management by drug sellers influences appropriate treatment of paediatric febrile illness in South Western Uganda: a quasi-experimental study
Integrated community case management by drug sellers influences appropriate treatment of paediatric febrile illness in South Western Uganda: a quasi-experimental study
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DOI：
10.1186/s12936-017-2072-9
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发表时间：
2017-10-23
期刊：
影响因子：
3
通讯作者：
Wamani, Henry
中科院分区：
文献类型：
--
作者：
Kitutu, Freddy Eric;Kalyango, Joan Nakayaga;Wamani, Henry
背景：尽管存在廉价和有效的儿童生存卫生技术，但发热病例管理是改善全球儿童健康的主要挑战。针对儿科发热性疾病的综合社区病例管理（iCCM）干预措施虽然已被乌干达卫生部采纳，将由社区卫生工作者实施，但并未解决难以获得拯救生命的药物和诊断方法的问题。因此，在乌干达西南部低疟疾传播地区的私人药店实施了iCCM干预措施，并评估了其对适当治疗儿科发烧的效果。方法：2013年6月至2015年9月，在乌干达西南部开展一项准实验研究，评估iCCM干预对药品销售商小儿发热管理和iCCM指南依从性的影响。干预组在研究开始前和结束后分别进行了212次和285次求助者退出访谈，而对照组在研究结束前和结束时分别进行了216次和268次问诊。干预效果是通过药物销售商治疗实践与国家治疗建议之间的差异分析来评估的。将观察到的求助者访谈比例与患者登记记录的5795例儿童访视的相应比例和干预药店中49例药物销售商与求助者接触的直接观察结果进行比较。结果：iCCM干预使无并发症疟疾、肺炎症状和非血性腹泻的适当治疗分别增加80.2% （95% CI 53.2 ~ 107.2）、65.5% （95% CI 51.6 ~ 79.4）和31.4% （95% CI 1.6 ~ 61.2）。在干预组中，药物销售商对肺炎症状的适当治疗和诊断测试的使用得分在寻求护理者退出访谈和直接观察中是相同的。儿童在干预区药店使用抗菌药物的比例呈线性趋势（负斜率，- 0.009 p值< 0.001）。结论：iCCM干预提高了对无并发症疟疾、肺炎症状和腹泻的适当治疗。在本研究中，药品销售商对iCCM指南的依从性很高，没有造成抗菌药物的过量处方。进一步的研究应该评估这种影响是否会随着时间的推移和在常规监督模式下持续。
Background: Fever case management is a major challenge for improved child health globally, despite existence of cheap and effective child survival health technologies. The integrated Community Case Management (iCCM) intervention of paediatric febrile illnesses though adopted by Uganda's Ministry of Health to be implemented by community health workers, has not addressed the in access to life-saving medicines and diagnostics. Therefore, the iCCM intervention was implemented in private drug shops and evaluated for its effect on appropriate treatment of paediatric fever in a low malaria transmission setting in South Western Uganda.Methods: From June 2013 to September 2015, the effect of the iCCM intervention on drug seller paediatric fever management and adherence to iCCM guidelines was assessed in a quasi-experimental study in South Western Uganda. A total of 212 care-seeker exit interviews were done before and 285 after in the intervention arm as compared to 216 before and 268 care-seeker interviews at the end of the study period in the comparison arm. The intervention effect was assessed by difference-in-difference analysis of drug seller treatment practices against national treatment recommendations between the intervention and comparison arms. Observed proportions among care-seeker interviews were compared with corresponding proportions from 5795 child visits recorded in patient registries and 49 direct observations of drug seller-care-seeker encounters in intervention drug shops.Results: The iCCM intervention increased the appropriate treatment of uncomplicated malaria, pneumonia symptoms and non-bloody diarrhoea by 80.2% (95% CI 53.2-107.2), 65.5% (95% CI 51.6-79.4) and 31.4% (95% CI 1.6-61.2), respectively. Within the intervention arm, drug seller scores on appropriate treatment for pneumonia symptoms and diagnostic test use were the same among care-seeker exit interviews and direct observation. A linear trend (negative slope, - 0.009 p value < 0.001) was observed for proportions of child cases prescribed any antimicrobial medicine in the intervention arm drug shops.Conclusions: The iCCM intervention improved appropriate treatment for uncomplicated malaria, pneumonia symptoms and diarrhoea. Drug seller adherence to iCCM guidelines was high, without causing excessive prescription of antimicrobial medicines in this study. Further research should assess whether this effect is sustained over time and under routine supervision models.