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Table 1 Description of the different components of the integrated community case management of pediatric febrile illness (iCCM) intervention implemented in study drug shops

From: Integrated community case management by drug sellers influences appropriate treatment of paediatric febrile illness in South Western Uganda: a quasi-experimental study

Intervention

Actor

Mechanism

Description

Beneficiary

Selection, training and work activities of drug sellers

Study team (study manager and field supervisor)

District drug inspector

District health educator

Telephone invitation of the drug sellers

Using national curriculum for the integrated community case management of paediatric febrile illnesses (iCCM) intervention [9, 10], drug sellers were trained in class lectures and hands-on practical sessions

61 drug shops were supplied with iCCM treatment algorithms, patient registers, respiratory rate counters, malaria rapid diagnostic tests and child medicines

Drug sellers were trained on case detection and classification according to simple clinical signs and/or diagnostic testing of three febrile child illnesses of acute respiratory illness (ARI), malaria and diarrheal diseases

The training covered signs and symptoms, danger signs, transmission, prevention, diagnostic testing and populations at risk of pneumonia, malaria and diarrhea, respectively

Also, the drug sellers were trained on filling in patient registries, referral, managing drug supplies, counseling care-seekers, adverse reaction monitoring and patient follow-up for outcome

Drug sellers from 61 registered drug shops

Information, education and communication (IEC)

Study manager, study field supervisor

District drug inspector

District health educator

Marking of intervention arm drug shops with A2L (access to life) poster

Community sensitization campaign using the MoH child health and malaria messages delivered through monthly radio talk shows by study and district staff and radio announcements

CHWs attended sensitization workshops organized by study and district staff

Messages about febrile illnesses among children, importance of diagnostic testing, treatment adherence, and what to do if symptoms of the sick child persist and implementation of iCCM in drug shops were discussed in the workshop

CHWs delivered these messages to households with U5 children by word-of-mouth

Drug sellers

Care-seekers

CHWs

Supply mechanism for medicines and diagnostics

Study manager and study field supervisor

Pharmaceutical wholesalers

The project identified pharmaceutical wholesalers to supply the study medicines at subsidized prices and diagnostics at no cost to intervention arm drug shops

The study purchased the pre-packaged medicines—ACTs, amoxicillin, zinc sulphate and ORS from manufacturers and provided them to pharmaceutical wholesalers in Mbarara

Drug sellers presented special study medicine order forms to pharmaceutical wholesalers for re-supply

Medicines were single-dose packed, color-coded for age and provided to drug shops at subsidized prices

The mRDT was a one-step, rapid, qualitative and differential test for detection of antigen—HRP-2 (histidine rich protein 2), specific for Plasmodium falciparum (CareStart™ from ACCESS BIO, INC. Ethiopian Branch, Yeka, Addis Ababa, Ethiopia), in finger prick blood [68]

The respiratory rate counters from Moneray International Limited [69]

The pre-packaged medicines included artemether-lumefantrine fixed-dose combination (from Ajanta Pharma Limited, Mumbai, India) dispersible tablets amoxicillin dispersible tablets (Amoxikidâ„¢, Kampala Pharmaceutical Industries (1996) Limited, Uganda) and for non-bloody diarrhea, combination of zinc sulphate dispersible tablets and oral rehydration salts (ORS) and artesunate suppositories for pre-referral treatment

Drug sellers

Support supervision and use of drug shop patient registry

Field supervisor trained in either clinical medicine or pharmacy

District drug inspector

District health educator

A field visit was conducted for every drug shop each month by field supervisor, other project staff and district health team

Intervention arm drug shops maintained a standard iCCM registry in triplicate copies where they recorded children seen, their symptoms (fever or history of fever, cough, fast or difficult breathing), diagnostic test done, the test results, treatment given and follow up action taken, respectively

Copies of filled iCCM register pages were retrieved from each study drug shop monthly

The study used all records of a total of 5975 children seen at the drug shops during the study period from February 2014 to September 2015

Drug sellers

Pharmaceutical wholesalers