Background
Methods
Intervention
Evaluation
Ethical considerations
Lessons learned
Design of the intervention
The involvement of the district health team and the community
Implementing the intervention
Evaluation of the intervention
The policy implications
Lessons learned | Key policy recommendations |
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A workshop was held involving stakeholders with experience in the private sector to design key elements of the intervention | To scale-up RDTs and ACT requires the involvement of the districts, NMCP, NDA and development partners, e.g., Clinton Health Access Initiative (CHAI), Malaria Consortium, FIND, Uganda Health Marketing group (UHMG), and community-based civil society organizations |
A baseline study noted poor regulation of drug shop practices | NDA should recruit more personnel to register drugs shops and support DADI in the supervision and regulation of drug shops. More personnel should be recruited at district level to assist DADI in supervision of drug shops |
A baseline study documented poor record keeping in drug shops | Government to introduce DHIS2 to private health sector in order to address issues of data reporting coverage and to facilitate planning and management of health services |
A baseline study noted poor quality of care at drug shops | Conditions should be attached to renewal of licences, mainly: minimum staff qualifications and evidence of continuing medical education |
Drug shops were giving injections and antibiotics which are beyond their scope | NDA, DADI and professional associations to intensify regulation and supervision of drugs shops and other private health sector outlets to ensure patient safety |
During evaluation of patient outcomes carewas taken not to influence DSV behaviour beyond what was realistic and sustainable | During scale-up RDTs and ACT, explaining the intervention and involving drug shops in the initial design processes generates acceptability and compliance |
Community sensitization was an important factor in increasing access to mRDT and ACT at drug shops | Future interventions should use multi-media channels to deliver messages on key interventions. There is need to intensify messages on non-malaria fevers and care-seeking practices |
There was poor referral uptake from drug shops because of mistrust between health facilities and drug shops | It is recommend that health workers be involved in training and supervision of the drug shops and in the design of interventions in the private sector |
For drug shops to get involved in public health activities there have to be incentives | District health teams and stakeholders who involve drug shops in public health interventions should give DSVs certificates or trophies as signs of motivation |
Content
Control clusters (n = 10) | Intervention clusters (n = 9) | ||
---|---|---|---|
Clients with complete data | 5797 | 7522 | |
Diagnosis and treatment | Frequency (%) | Frequency (%) | |
Blood slide-positive | 1841 (31.8) | 3271 (43.5) | |
Malaria treatment by infection status | |||
Blood slide-negative, received no ACT1
| 8 (0.2) | 2662 (62.6) | |
Blood slide-negative, received ACT | 3948 (99.8) | 1589 (37.4) | |
Trial endpoints | Cluster mean (95 % CI) | Cluster mean (95 % CI) | |
Proportion of blood slide-negative patients receiving ACT | 99.8 (99.5−100.0) | 42.4 (28.8−56.0) | p < 0.001 |
Proportion of febrile patients receiving appropriate treatment for malaria with ACT (95 % CI) | 33.7 (25.8−41.5) | 72.9 (67.3−78.6) | p < 0.001 |
Proportion of febrile patients seen within 24 h of onset of symptoms receiving appropriate treatment | 26.8 (19.5−34.2) | 52.8 (45.9−59.7) | p < 0.001 |
Proportion of febrile patients referred* | 244 (3.6 %) | 1019 (11.9 %) | p < 0.001 |
Reasons for referral | |||
Danger signs | 105 (46.9 %) | 667 (78.7 %) | p < 0.001 |
Other signs | 119 (53.1 %) | 180 (21.3 %) | |
Recommendations from clients | |||
What do you recommend with regard to DSV? | |||
Improve health facilities of DSVs | 16 (19.5 %) | 19 (25.3) | |
Improve geographical access | 2 (2.4) | 3 (4.0) | |
Cheaper medication | 8 (9.8) | 12 (16.0) | |
Greater stock and variety of medication | 19 (23.2) | 8 (10.7) | |
Show patients test results RDT/blood samples | 4 (4.9) | 3 (4.0) | |
Continue RDT use/expand to other DSVs | 26 (31.7) | 10 (13.3) | |
Develop RDTs for other illnesses | 11 (13.4) | 20 (26.7) | |
Which aspects of the treatment and advice you received at the drug shop were you happy with? | |||
Patient recovered/treatment worked | 118 (54.4) | 91 (41.5) | |
Standard and form of healthcare provided | 111 (51.1) | 81 (37.0) | |
Price of treatment and provision of credit | 20 (9.2) | 13 (5.9) | |
Health facilities and stock of medication | 9 (4.1) | 2 (0.9) | |
Offered referral and/or conditional advice | 4 (1.8) | 6 (2.7) | |
Use of ‘blood test’/RDT | 19 (8.8) | 101 (46.1) |