Project Lead(s): Denise Buchner
In many countries, private sector health providers, including informal drug shops, are routinely consulted when illness strikes.
The World Health Organization (WHO) estimates that between 30% and 70% of febrile children in developing countries are treated in the private sector, including through drug shops.
Other studies report that between 39% and 53% of people who seek treatment for an illness consult a private health provider first, including general merchandise sellers, pharmacies, for-profit providers and drug sellers.
Many private sector providers are unlicensed and unsupervised. They often diagnose illnesses incorrectly, sell reduced doses of medicines, expired drugs and drugs that are not recommended by national guidelines.
The objective of the project was to evaluate the feasibility of implementing Integrated Community Case Management (ICCM) for the management of childhood illnesses in unlicensed drug shops in Uganda.
Engaging private drug sellers to diagnose and treat common childhood diseases might be a sustainable method of ICCM delivery to reduce child mortality, and might also encourage regulation and registration of drug shops.
ICCM is currently delivered through Community Health Workers (CHWs) who are trained to recognize uncomplicated diarrhea, malaria and pneumonia, and to distribute appropriate treatments.
ICCM delivered by drug shops – whose owners often have a secondary education – could be a sustainable model for healthcare delivery in rural Uganda, with potential for improved health outcomes similar to those demonstrated by ICCM by CHWs.
The Kamuli District was selected for this project, as it is remote and many areas are far from health facilities.
The project team mapped out 215 drug shops, 126 of which were unlicensed, and selected 12 drug shop proprietors for training.
Six months after ICCM, the intervention drug shops demonstrated a remarkable improvement in appropriate treatment of fever, cough and diarrhea for children under five years of age, compared to baseline.
For example, 73.3% (n = 300) children with fever received an RDT (rapid diagnostic test) for malaria, compared to 0.6% at baseline, indicating a remarkable increase of accurate diagnosis of children with fever.
Of the children who received a positive RDT, 88.2% received some kind of Artemsinin therapy (ACT), versus only half of children with a positive RDT who received any kind of ACT at baseline.
In addition, the training reduced the number of cases of patients being given wrong medication or no medication.
The current recommended treatment for presumed pneumonia in children under five years of age is amoxicillin. At baseline, only 16.3% of children with pneumonia received any kind of amoxicillin but, after the intervention, 66.1% received amoxicillin.
The team plans to scale up the project in the Kamuli district and beyond in Uganda. They are also preparing manuscripts to disseminate information about the project.