scholarly journals Effectiveness of Peer-Supervision on Paediatric Fever Treatment Among Registered Private Drug Sellers in East-Central Uganda: An Interrupted Time Series Analysis

2020 ◽  
Author(s):  
Arthur Bagonza ◽  
Freddy Eric Kitutu ◽  
Stefan Peterson ◽  
Andreas Mårtensson ◽  
Milton Mutto ◽  
...  
Keyword(s):  
Time Series ◽  
Rural Areas ◽  
Uncomplicated Malaria ◽  
Interrupted Time Series ◽  
Bloody Diarrhoea ◽  
Drug Shop ◽  
Peer Supervision ◽  
East Central ◽  
Appropriate Treatment ◽  
Drug Sellers

Abstract Background: Appropriate treatment of paediatric fever in rural areas remains a challenge and may be partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer-supervision among drug sellers on appropriate treatment of pneumonia symptoms, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age in the intervention (Luuka) and comparison (Buyende) districts, in East-Central Uganda.Methods: Data on pneumonia symptoms, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age was abstracted from drug shop sick child registers over a 12-month period; six months before and six months after introduction of peer-supervision. Interrupted time series was applied to determine the effectiveness of the peer-supervision intervention on appropriate treatment of pneumonia, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age attending drug shops in East Central Uganda.Results: The proportion of children treated appropriately for pneumonia symptoms was 10.84% (P < 0.05, CI = [1.75, 19.9]) higher, for uncomplicated malaria was 1.46% (P = 0.79, CI = [-10.43, 13.36]) higher, and for non-bloody diarrhoea was 4.00% (p < 0.05, CI = [-7.95, -0.13]) lower in the intervention district than the comparison district, respectively.Post-intervention trend results showed an increase of 1.21% (p =0.008, CI = [0.36, 2.05]) in the proportion appropriately treated for pneumonia symptoms, no difference in appropriate treatment for uncomplicated malaria, and a reduction of 1% (p <0.06, CI = [-1.95, 0.02]) in the proportion of children appropriately treated for non-bloody diarrhoea, respectively.Conclusions: Peer-supervision increased the proportion of children less than five years of age that received appropriate treatment for pneumonia symptoms but not for uncomplicated malaria and non-bloody diarrhoea. Implementation of community level interventions to improve paediatric fever management should consider including peer-supervision among drug sellers.

scholarly journals Peer supervision experiences of drug sellers in a rural district in East-Central Uganda: a qualitative study

2020 ◽  
Author(s):  
Arthur Bagonza ◽  
Henry Wamani ◽  
Stefan Peterson ◽  
Andreas Mårtensson ◽  
Milton Mutto ◽  
...  
Keyword(s):  
Sick Child ◽  
Health Workers ◽  
Performance Outcomes ◽  
Drug Shop ◽  
Peer Supervision ◽  
East Central ◽  
Good Relationship ◽  
Children Under Five ◽  
Under Five ◽  
Drug Sellers

Abstract BackgroundSupport supervision improves performance outcomes among health workers. However, the national professional guidelines for new licenses and renewal for class C drug shops in Uganda prescribe self-supervision of licensed private drug sellers.As such, inappropriate treatment of malaria, pneumonia and diarrhoea among children under five years of age continues unabated. This study assessed experiences of drug sellers and peer supervisors at the end of a peer supervision intervention in Luuka district in East Central Uganda.MethodsEightin-depth interviews (IDIs) were held with peer supervisors while five focus group discussions (FGDs) were conducted among registered drug sellersat the end of the peer supervision intervention. The study assessed experiences and challenges of peer supervisors and drug sellers regarding peer supervision.Transcripts were imported into Atlas ti 7 qualitative data management software (ATLAS.ti GmbH, Berlin) where they were analysedusing thematic content analysis.ResultsInitially, peer supervisors were disliked and regarded as another extension of drug inspectors by drug sellers. However, with time a good relationship was established between drug sellers and peer supervisors leading to regular, predictable and supportive peer supervision. This increased confidence of drug sellers in using respiratory timers and rapid diagnostic tests in diagnosing pneumonia symptoms and uncomplicated malaria respectively among children under five years. There was also an improvement in completing the sick child register which was used for self-assessment by drug sellers. The drug shop association was mentioned as a place where peer supervision should be anchored since it was a one-stop center for sharing experiences and continuous professional development. Drug sellers proposed including community health workers in monthly drug shop association meetings so that they mayalso gain from the associated benefits. Untimely completion of the sick child registers by drug sellers and inadequate financial resources were the main peer supervision challenges mentioned.ConclusionDrug sellers benefitted from peer supervision by developing a good relationship with peer supervisors.This relationship guaranteed reliable and predictable supervision ultimately leading to improved treatment practices.There is need to explore the minimum resources needed for peer supervision of drug sellers to further inform practice and policy.

scholarly journals Peer supervision experiences of drug sellers in a rural district in East-Central Uganda: a qualitative study

2020 ◽  
Author(s):  
Arthur Bagonza ◽  
Henry Wamani ◽  
Stefan Peterson ◽  
Andreas Mårtensson ◽  
Milton Mutto ◽  
...  
Keyword(s):  
Sick Child ◽  
Health Workers ◽  
Performance Outcomes ◽  
Drug Shop ◽  
Peer Supervision ◽  
East Central ◽  
Good Relationship ◽  
Children Under Five ◽  
Under Five ◽  
Drug Sellers

Abstract Background Support supervision improves performance outcomes among health workers. However, the national professional guidelines for new licenses and renewal for class C drug shops in Uganda prescribe self-supervision of licensed private drug sellers. As such, inappropriate treatment of malaria, pneumonia and diarrhoea among children under five years of age continues unabated. This study assessed experiences of drug sellers and peer supervisors at the end of a peer supervision intervention in Luuka district in East Central Uganda. Methods Eight in-depth interviews (IDIs) were held with peer supervisors while five focus group discussions (FGDs) were conducted among registered drug sellers at the end of the peer supervision intervention. The study assessed experiences and challenges of peer supervisors and drug sellers regarding peer supervision. Transcripts were imported into Atlas ti 7 qualitative data management software (ATLAS.ti GmbH, Berlin) where they were analysed using qualitative thematic content analysis. Results Initially, peer supervisors were disliked and regarded as another extension of drug inspectors by drug sellers. However, with time a good relationship was established between drug sellers and peer supervisors leading to regular, predictable and supportive peer supervision. This increased confidence of drug sellers in using respiratory timers and rapid diagnostic tests in diagnosing pneumonia symptoms and uncomplicated malaria respectively among children under five years. There was also an improvement in completing the sick child register which was used for self-assessment by drug sellers. The drug shop association was mentioned as a place where peer supervision should be anchored since it was a one-stop center for sharing experiences and continuous professional development. Drug sellers proposed including community health workers in monthly drug shop association meetings so that they may also gain from the associated benefits. Untimely completion of the sick child registers by drug sellers and lack of adequate resources were the main peer supervision challenges mentioned. Conclusion Drug sellers benefitted from peer supervision by developing a good relationship with peer supervisors. This relationship guaranteed reliable and predictable supervision ultimately leading to improved treatment practices. There is need to explore the bare minimum resources needed for peer supervision.

scholarly journals Peer supervision experiences of drug sellers in a rural district in East-Central Uganda: a qualitative study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Arthur Bagonza ◽  
Henry Wamani ◽  
Stefan Peterson ◽  
Andreas Mårtensson ◽  
Milton Mutto ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Rural District ◽  
Peer Supervision ◽  
East Central ◽  
Drug Sellers

scholarly journals Using a Call Center to Reduce Harm From Self-Administration of Reproductive Health Medicines in Bangladesh: Interrupted Time-Series

10.2196/12233 ◽  
2019 ◽  
Vol 5 (3) ◽  
pp. e12233
Author(s):  
Katherine Keenan ◽  
Katharine Footman ◽  
Munnaf Sadekin ◽  
Kate Reiss ◽  
Reena Yasmin ◽  
...  
Keyword(s):  
Time Series ◽  
Side Effects ◽  
Health Care Providers ◽  
Call Center ◽  
Interrupted Time Series ◽  
Care Providers ◽  
Self Administration ◽  
Potential Harm ◽  
Drug Sellers ◽  
Over Time

Background Annually, there are approximately 25 million unsafe abortions, and this remains a leading cause of maternal morbidity and mortality. In settings where abortion is restricted, women are increasingly able to self-manage abortions by purchasing abortion medications such as misoprostol and mifepristone (RU-486) from pharmacies or other drug sellers. Better availability of these drugs has been shown to be associated with reductions in complications from unsafe abortions. In Bangladesh, abortion is restricted; however, menstrual regulation (MR) was introduced in the 1970s as an interim method of preventing pregnancy. Pharmacy provision of medications for MR is widespread, but customers purchasing these drugs from pharmacies often do not have access to quality information on dosage and potential complications. Objective This study aimed to describe a call center intervention in Bangladesh, and assess call center use over time and how this changed when a new MR product (combined mifepristone-misoprostol) was introduced into the market. Methods In 2010, Marie Stopes Bangladesh established a care provider–assisted call center to reduce potential harm from self-administration of MR medications. The call center number was advertised widely in pharmacies and on MR product packaging. We conducted a secondary analysis of routine data collected by call center workers between July 2012 and August 2016. We investigated the reported types of callers, the reason for call, and reported usage of MR products before and after November 2014. We used an interrupted time series (ITS) analysis to formally assess levels of change in caller characteristics and reasons for calling. Results Over the 4-year period, 287,095 calls about MR were received and the number of users steadily increased over time. The most common callers (of 287,042 callers) were MR users (67,438, 23.49%), their husbands (65,999, 22.99%), pharmacy workers (65,828, 22.93%), and village doctors (56,036, 19.52%). Most MR calls were about misoprostol, but after November 2014, a growing proportion of calls were about the mifepristone-misoprostol regimen. The most common reasons (of 287,042 reasons) for calling were to obtain information about the regimen (208,605, 72.66%), to obtain information about side effects (208,267, 72.54%), or to report side effects (49,930, 17.39%). The ITS analyses showed that after November 2014, an increasing number of calls were from MR users who had taken the complete regimen (P=.02 and who were calling to discuss reported side effects (P=.01) and pain medication (P=.01), and there were fewer calls asking about dosages (P<.001). Conclusions The high call volume suggests that this call center intervention addressed an unmet demand for information about MR medications from both MR users and health care providers. Call center interventions may improve the quality of information available by providing information directly to MR users and drug sellers, and thus reducing the potential harm from self-management of MR medications.

scholarly journals Using a Call Center to Reducae Harm From Self-Administration of Abortion Medicines in Bangladesh: Interrupted Time-Series (Preprint)

2018 ◽  
Author(s):  
Katherine Keenan ◽  
Katharine Footman ◽  
Munnaf Sadekin ◽  
Kate Reiss ◽  
Reena Yasmin ◽  
...  
Keyword(s):  
Time Series ◽  
Side Effects ◽  
Health Care Providers ◽  
Call Center ◽  
Interrupted Time Series ◽  
Care Providers ◽  
Self Administration ◽  
Potential Harm ◽  
Drug Sellers ◽  
Over Time

BACKGROUND Annually, there are approximately 25 million unsafe abortions, and this remains a leading cause of maternal morbidity and mortality. In settings where abortion is restricted, women are increasingly able to self-manage abortions by purchasing abortion medications such as misoprostol and mifepristone (RU-486) from pharmacies or other drug sellers. Better availability of these drugs has been shown to be associated with reductions in complications from unsafe abortions. In Bangladesh, abortion is restricted; however, menstrual regulation (MR) was introduced in the 1970s as an interim method of preventing pregnancy. Pharmacy provision of medications for MR is widespread, but customers purchasing these drugs from pharmacies often do not have access to quality information on dosage and potential complications. OBJECTIVE This study aimed to describe a call center intervention in Bangladesh, and assess call center use over time and how this changed when a new MR product (combined mifepristone-misoprostol) was introduced into the market. METHODS In 2010, Marie Stopes Bangladesh established a care provider–assisted call center to reduce potential harm from self-administration of MR medications. The call center number was advertised widely in pharmacies and on MR product packaging. We conducted a secondary analysis of routine data collected by call center workers between July 2012 and August 2016. We investigated the reported types of callers, the reason for call, and reported usage of MR products before and after November 2014. We used an interrupted time series (ITS) analysis to formally assess levels of change in caller characteristics and reasons for calling. RESULTS Over the 4-year period, 287,095 calls about MR were received and the number of users steadily increased over time. The most common callers (of 287,042 callers) were MR users (67,438, 23.49%), their husbands (65,999, 22.99%), pharmacy workers (65,828, 22.93%), and village doctors (56,036, 19.52%). Most MR calls were about misoprostol, but after November 2014, a growing proportion of calls were about the mifepristone-misoprostol regimen. The most common reasons (of 287,042 reasons) for calling were to obtain information about the regimen (208,605, 72.66%), to obtain information about side effects (208,267, 72.54%), or to report side effects (49,930, 17.39%). The ITS analyses showed that after November 2014, an increasing number of calls were from MR users who had taken the complete regimen (P=.02 and who were calling to discuss reported side effects (P=.01) and pain medication (P=.01), and there were fewer calls asking about dosages (P<.001). CONCLUSIONS The high call volume suggests that this call center intervention addressed an unmet demand for information about MR medications from both MR users and health care providers. Call center interventions may improve the quality of information available by providing information directly to MR users and drug sellers, and thus reducing the potential harm from self-management of MR medications.

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