title: Increased access to care and appropriateness of treatment at private sector drug shops with integrated management of malaria, pneumonia and diarrhoea: a quasi-experimental study in Uganda.
abstract: BACKGROUND
  Drug shops are a major source of care for children in low income countries but they provide sub-standard care. We assessed the feasibility and effect on quality of care of introducing diagnostics and pre-packaged paediatric-dosage drugs for malaria, pneumonia and diarrhoea at drug shops in Uganda.
  
  
  METHODS
  We adopted and implemented the integrated community case management (iCCM) intervention within registered drug shops. Attendants were trained to perform malaria rapid diagnostic tests (RDTs) in each fever case and count respiratory rate in each case of cough with fast/difficult breathing, before dispensing recommended treatment. Using a quasi-experimental design in one intervention and one non-intervention district, we conducted before and after exit interviews for drug seller practices and household surveys for treatment-seeking practices in May-June 2011 and May-June 2012. Survey adjusted generalized linear models and difference-in-difference analysis was used.
  
  
  RESULTS
  3759 (1604 before/2155 after) household interviews and 943 (163 before/780 after) exit interviews were conducted with caretakers of children under-5. At baseline, no child at a drug shop received any diagnostic testing before treatment in both districts. After the intervention, while no child in the non-intervention district received a diagnostic test, 87.7% (95% CI 79.0-96.4) of children with fever at the intervention district drug shops had a parasitological diagnosis of malaria, prior to treatment. The prevalence ratios of the effect of the intervention on treatment of cough and fast breathing with amoxicillin and diarrhoea with ORS/zinc at the drug shop were 2.8 (2.0-3.9), and 12.8 (4.2-38.6) respectively. From the household survey, the prevalence ratio of the intervention effect on use of RDTs was 3.2 (1.9-5.4); Artemisinin Combination Therapy for malaria was 0.74 (0.65-0.84), and ORS/zinc for diarrhoea was 2.3 (1.2-4.7).
  
  
  CONCLUSIONS
  iCCM can be utilized to improve access and appropriateness of care for children at drug shops.
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway; School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Awor
authors.affiliation: School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Henry
authors.initials: H
authors.lastname: Wamani
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskar
authors.affiliation: Medicines for Malaria Venture, Geneva, Switzerland.
authors.forename: George
authors.initials: G
authors.lastname: Jagoe
authors.affiliation: School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda; Global Health, Karolinska Institutet, Stockholm, Sweden; International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
mesh_terms: D017028:Caregivers; D002675:Child, Preschool; D003967:Diarrhea / Q000175:diagnosis / Q000188:drug therapy*; D019468:Disease Management; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D010594:Pharmacies; D010865:Pilot Projects; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy*; D015995:Prevalence; D017149:Private Sector; D014454:Uganda