awor_extending_amfm_to_iccm_2_sp

Extending AMFm to Integrated Case Management of Malaria, Pneumonia and Diarrhoea in Drug Shops in Uganda Phyllis Awor Henry Wamani George Jagoe Stefan Peterson

Background and Introduction • 6.9 million children under 5 years of age die every year • 60% of these deaths caused by malaria, pneumonia and diarrhoea • Malaria, pneumonia and diarrhoea all manifest as acute febrile illness with overlapping symptoms • Traditional treatment – presumptive antimalarials

Symptom overlap of sick children in Ugandan Health centers (Kallander et al 2004)

From Home Management of Malaria to Integrated Community Case Management of Malaria, Pneumonia and Diarrhoea (iCCM) iCCM Tool kit

• 2002 – 2009 Home Based Management of Fever strategy in Uganda – Antimalarials only

• 2010 iCCM policy – WHO/UNICEF recommendation

• Scale up through Community Health Workers (CHWs) across Africa

Problem Statement • iCCM is promoted through Public sector, yet – 2/3 febrile children in Uganda treated by

private sector, especially drug shops – Quality of care is poor and drug use irrational – AMFm while popular overuses ACT and disregards other causes of fever than malaria

Objective Determine feasibility and effectiveness of diagnostics and prepacked drugs for malaria, pneumonia and diarrhoea in registered drug shops in Eastern Uganda

Methods Quasi Experimental Design

Intervention district:

Comparison district:

N = 44 drug shops

N = 40 drug shops Standard AMFm

iCCM 1.

2.

3.

4.

Subsidized pre-packed drugs 1. Presumptive treatment of fever with ACT Free Diagnostics Training Social Marketing

Methods • Baseline - Endline Assessments • 8 months duration (2011/12) Exit interviews at drug shops (700) Household surveys – care seeking and Rx practices (2140) • Analysis Correct treatment: drug, dose, duration Sources of care

Correct treatment at Drug Shop –Exit Interviews Treatment of fever at drug shop 100 90 83.6

80

Percentage

70 60 50

47.6

40 30 20

31

16.2

10 0

Baseline

8 months

Correct Treatment at the Drug Shop – From Exit Interviews Treatment of Cough with difficult breathing

90

90

80

80

70

74 Percentage

70 Percentage

Treatment of Diarrhoea

60 50

60 50 40

40 33

30

30

20

20

10

10

0

76

5 0

0

Baseline

8 Months

0

Baseline

8 Months

Care seeking – Household Survey First Point of Care for Febrile Child - Intervention District

100% 90%

29.8

80%

55.5

70%

Other Drug shop

60%

Private clinic

50%

Health Centre Managed at home

40% 30%

20.1

Health Ctr

20.7

20% 10% 0%

Baseline (N=477)

8 Months (N=742)

Care seeking – Household Survey First Point of Care for Febrile Child - Control District

100% 90% 80%

Drug Shops

34.7

30 Other

70%

Priv Clinics

Drug shop

60%

Private clinic

Health Ctr

50%

Health centre Managed at home

40% 30% 20%

Home care

43

32.5

10% 0% Baseline (N=457)

8 Months (N=727)

Conclusions • Parents willing to bring children to drug shops • Improved quality of care at drug shops • AMFm can be extended to integrate management of malaria, pneumonia and diarrhea • Adherence to RDT results may require alternative appropriate treatments

Acknowledgements

• Einhorn Family Foundation, Sweden • Caretakers and children in study districts • Data collectors