title: Drug seller adherence to clinical protocols with integrated management of malaria, pneumonia and diarrhoea at drug shops in Uganda.
abstract: BACKGROUND
  Drug shops are usually the first source of care for febrile children in Uganda although the quality of care they provide is known to be poor. Within a larger quasi-experimental study introducing the WHO/UNICEF recommended integrated community case management (iCCM) of malaria, pneumonia and diarrhoea intervention for community health workers in registered drug shops, the level of adherence to clinical protocols by drug sellers was determined.
  
  
  METHODS
  All drug shops (N = 44) in the intervention area were included and all child visits (N = 7,667) from October 2011-June 2012 to the participating drug shops were analysed. Drug shops maintained a standard iCCM register where they recorded the children seen, their symptoms, diagnostic test performed, treatments given and actions taken. The proportion of children correctly assessed and treated was determined from the registers.
  
  
  RESULTS
  Malaria management: 6,140 of 7,667 (80.1%) total visits to drug shops were of children with fever. 5986 (97.5%) children with fever received a malaria rapid diagnostic test (RDT) and the RDT positivity rate was 78% (95% CI 77-79). 4,961/5,307 (93.4%) children with a positive RDT received artemisinin combination therapy. Pneumonia management: after respiratory rate assessment of children with cough and fast/difficult breathing, 3,437 (44.8%) were categorized as "pneumonia", 3,126 (91.0%) of whom received the recommended drug-amoxicillin. Diarrhoea management: 2,335 (30.5%) child visits were for diarrhoea with 2,068 (88.6%) correctly treated with oral rehydration salts and zinc sulphate. Dual/Triple classification: 2,387 (31.1%) children had both malaria and pneumonia and 664 (8.7%) were classified as having three illnesses. Over 90% of the children with dual or triple classification were treated appropriately. Meanwhile, 381 children were categorized as severely sick (with a danger sign) with 309 (81.1%) of them referred for appropriate management.
  
  
  CONCLUSIONS
  With the introduction of the iCCM intervention at drug shops in Eastern Uganda, it was possible to achieve high adherence to the treatment protocols, which is likely compatible with increased quality of care.
authors.affiliation: Department of Global Public Health and Primary Health Care, Centre for International Health, University of Bergen, PO Box 7800, 5020, Bergen, Norway. pawor@musph.ac.ug.|Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda. pawor@musph.ac.ug.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Awor
authors.affiliation: Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda. hwamani@musph.ac.ug.
authors.forename: Henry
authors.initials: H
authors.lastname: Wamani
authors.affiliation: Department of Global Public Health and Primary Health Care, Centre for International Health, University of Bergen, PO Box 7800, 5020, Bergen, Norway. Thorkild.Tylleskar@cih.uib.no.
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskar
authors.affiliation: Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda. Stefan.Peterson@ki.se.|Global Health, Karolinska Institutet, Stockholm, Sweden. Stefan.Peterson@ki.se.|International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden. Stefan.Peterson@ki.se.
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000930:Antidiarrheals / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000706:statistics & numerical data*; D003967:Diarrhea / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D000900:Anti-Bacterial Agents; D000930:Antidiarrheals; D000962:Antimalarials