title: Participatory healthcare-provider orientation to improve artemether-lumefantrine-based drug treatment of uncomplicated malaria: a cluster quasi-experimental study.
abstract: OBJECTIVE
  To assess the effect of participatory healthcare-provider orientation in enhancing patient knowledge, appropriate prescribing and dispensing of artemether-lumefantrine, during drug treatment of uncomplicated malaria.
  
  
  METHODS
  A cluster quasi-experimental study. The authors developed strategies to address challenges encountered by healthcare providers during clinical management of malaria. The primary outcome was patient knowledge on prescribed malaria drug treatment. Secondary outcomes were appropriate prescribing and provision of adequate drug dispensing information. The authors used generalised estimating equation logistic regression to investigate correlates of appropriate use of artemether-lumefantrine.
  
  
  RESULTS
  The proportion of patients or caretakers of paediatric patients sufficiently knowledgeable about malaria treatment increased from 16/85 (18.8%) at baseline to 33/96 (34.4%) at evaluation, OR 2.26 (95% CI 1.13 to 4.49), p=0.020, in the intervention, and fell slightly from 49/134 (36.6%) to 35/114 (30.7%), OR 0.77, (95% CI 0.45 to 1.31), p=0.331 in the control district. This was enhanced by the existence of drug-dispensing standard operating procedures (adjusted OR 1.85, 95% CI 0.98 to 3.50; p=0.057). The proportion of appropriate prescriptions increased from 61/87 (70.1%) to 94/112 (83.9%) in the intervention district, OR 2.23 (95% CI 1.13 to 4.40), p=0.020 and reduced from 91/115 (79.1%) to 75/112 (67.0%) in the control district, OR 0.53, (95% CI 0.29 to 0.97), p=0.040. The frequency of adequately dispensed prescriptions increased in the intervention district (34(32.4%) to 53(45.3%), OR 1.73 (95% CI 1.00 to 2.99), p=0.050) but decreased in the control location (94 (69.6%) to 71 (52.6%), OR 0.48 (95% CI 0.29 to 0.80), p=0.004).
  
  
  CONCLUSIONS
  Participatory healthcare-provider orientation enhanced patient knowledge, healthcare provider prescribing and dispensing of artemether-lumefantrine, bolstered by adequate medication counselling and use of drug-dispensing standard operating procedures.
authors.affiliation: Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda. nanyama@chs.mak.ac.ug
authors.forename: Norbert G
authors.initials: NG
authors.lastname: Anyama
authors.forename: James K
authors.initials: JK
authors.lastname: Tibenderana
authors.forename: Paul
authors.initials: P
authors.lastname: Kutyabami
authors.forename: Pakoyo F
authors.initials: PF
authors.lastname: Kamba
authors.forename: Freddy E
authors.initials: FE
authors.lastname: Kitutu
authors.forename: Richard O
authors.initials: RO
authors.lastname: Adome
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage / Q000627:therapeutic use; D016000:Cluster Analysis; D055812:Community-Based Participatory Research; D003376:Counseling / Q000706:statistics & numerical data*; D004338:Drug Combinations; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage / Q000627:therapeutic use; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008288:Malaria / Q000188:drug therapy / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D010361:Patients / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011369:Professional-Patient Relations; D016896:Treatment Outcome; D014454:Uganda
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes