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 |