Increased Access to Care and Appropriateness of Treatment at Private Sector Drug Shops with Integrated Management of Malaria, Pneumonia and Diarrhoea: A Quasi-Experimental Study in Uganda
Increased Access to Care and Appropriateness of Treatment at Private Sector Drug Shops with Integrated Management of Malaria, Pneumonia and Diarrhoea: A Quasi-Experimental Study in Uganda
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DOI：
10.1371/journal.pone.0115440
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发表时间：
2014-12-26
期刊：
影响因子：
3.7
通讯作者：
Peterson, Stefan
中科院分区：
文献类型：
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作者：
Awor, Phyllis;Wamani, Henry;Peterson, Stefan
简介：药店是低收入国家儿童护理的主要来源，但它们提供的护理低于标准。我们评估的可行性和效果的护理质量，引入诊断和预包装的儿科剂量的药物疟疾，肺炎和腹泻在drug shops in Uganda.Methods：我们通过并实施了综合社区病例管理（iCCM）干预注册药店内。对护理人员进行了培训，使他们能够对每个发热病例进行疟疾快速诊断测试，并在提供建议的治疗之前，计算每个咳嗽伴呼吸急促/困难病例的呼吸频率。在一个干预区和一个非干预区使用准实验设计，我们在2011年5月至6月和2012年5月至6月对药品销售商的做法和寻求治疗的做法进行了退出访谈和家庭调查。调查调整广义线性模型和差异中的差异analysis.Results：3759（1604前/2155后）家庭访谈和943（163前/780后）退出访谈进行了5岁以下儿童的照顾者。基线时，两个地区的药店没有儿童在治疗前接受任何诊断检测。干预后，虽然非干预区没有儿童接受诊断测试，但在干预区药店，87.7%（95%CI 79.0-96.4）的发热儿童在治疗前有疟疾的寄生虫学诊断。在药店用阿莫西林治疗咳嗽和呼吸急促以及用口服补液盐/锌治疗腹泻的干预效果的患病率分别为2.8（2.0-3.9）和12.8（4.2-38.6）。从家庭调查来看，RDT使用干预效果的患病率为3.2（1.9-5.4）;青蒿素联合疗法治疗疟疾的患病率为0.74（0.65-0.84），口服补液盐/锌治疗腹泻的患病率为2.3（1.2-4.7）。结论：iCCM可用于改善儿童在药店获得护理的机会和适当性。
Introduction: Drug shops are a major source of care for children in low income countries but they provide sub-standard care. We assessed the feasibility and effect on quality of care of introducing diagnostics and pre-packaged paediatric-dosage drugs for malaria, pneumonia and diarrhoea at drug shops in Uganda.Methods: We adopted and implemented the integrated community case management (iCCM) intervention within registered drug shops. Attendants were trained to perform malaria rapid diagnostic tests (RDTs) in each fever case and count respiratory rate in each case of cough with fast/difficult breathing, before dispensing recommended treatment. Using a quasi-experimental design in one intervention and one non-intervention district, we conducted before and after exit interviews for drug seller practices and household surveys for treatment-seeking practices in May-June 2011 and May-June 2012. Survey adjusted generalized linear models and difference-in-difference analysis was used.Results: 3759 (1604 before/2155 after) household interviews and 943 (163 before/780 after) exit interviews were conducted with caretakers of children under-5. At baseline, no child at a drug shop received any diagnostic testing before treatment in both districts. After the intervention, while no child in the non-intervention district received a diagnostic test, 87.7% (95% CI 79.0-96.4) of children with fever at the intervention district drug shops had a parasitological diagnosis of malaria, prior to treatment. The prevalence ratios of the effect of the intervention on treatment of cough and fast breathing with amoxicillin and diarrhoea with ORS/zinc at the drug shop were 2.8 (2.0-3.9), and 12.8 (4.2-38.6) respectively. From the household survey, the prevalence ratio of the intervention effect on use of RDTs was 3.2 (1.9-5.4); Artemisinin Combination Therapy for malaria was 0.74 (0.65-0.84), and ORS/zinc for diarrhoea was 2.3 (1.2-4.7).Conclusion: iCCM can be utilized to improve access and appropriateness of care for children at drug shops.