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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 (Amoxikid™, 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