title: Increased use of community medicine distributors and rational use of drugs in children less than five years of age in Uganda caused by integrated community case management of fever.
abstract: We compared use of community medicine distributors (CMDs) and drug use under integrated community case management and home-based management strategies in children 6-59 months of age in eastern Uganda. A cross-sectional study with 1,095 children was nested in a cluster randomized trial with integrated community case management (CMDs treating malaria and pneumonia) as the intervention and home-based management (CMDs treating only malaria) as the control. Care-seeking from CMDs was higher in intervention areas (31%) than in control areas (22%; P = 0.01). Prompt and appropriate treatment of malaria was higher in intervention areas (18%) than in control areas (12%; P = 0.03) and among CMD users (37%) than other health providers (9%). The mean number of drugs among CMD users compared with other health providers was 1.6 versus 2.4 in intervention areas and 1.4 versus 2.3 in control areas. Use of CMDs was low. However, integrated community case management of childhood illnesses increased use of CMDs and rational drug use.
authors.forename: Joan N
authors.initials: JN
authors.lastname: Kalyango
authors.forename: Ann
authors.initials: A
authors.lastname: Lindstrand
authors.forename: Elizeus
authors.initials: E
authors.lastname: Rutebemberwa
authors.forename: Sarah
authors.initials: S
authors.lastname: Ssali
authors.forename: Daniel
authors.initials: D
authors.lastname: Kadobera
authors.forename: Charles
authors.initials: C
authors.lastname: Karamagi
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
authors.forename: Tobias
authors.initials: T
authors.lastname: Alfven
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D001944:Breath Tests; D019090:Case Management; D002675:Child, Preschool; D016000:Cluster Analysis; D003153:Community Health Services; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008288:Malaria / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D015999:Multivariate Analysis; D011014:Pneumonia / Q000188:drug therapy / Q000401:mortality*; D014454:Uganda / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials