title: Effect of integrated infectious disease training and on-site support on the management of childhood illnesses in Uganda: a cluster randomized trial.
abstract: BACKGROUND
  The Integrated Infectious Disease Capacity-Building Evaluation (IDCAP) was designed to test the effects of two interventions, Integrated Management of Infectious Disease (IMID) training and on-site support (OSS), on clinical practice of mid-level practitioners. This article reports the effects of these interventions on clinical practice in management of common childhood illnesses.
  
  
  METHODS
  Two trainees from each of 36 health facilities participated in the IMID training. IMID was a three-week core course, two one-week boost courses, and distance learning over nine months. Eighteen of the 36 health facilities were then randomly assigned to arm A, and participated in OSS, while the other 18 health facilities assigned to arm B did not. Clinical faculty assessed trainee practice on clinical practice of six sets of tasks: patient history, physical examination, laboratory tests, diagnosis, treatment, and patient/caregiver education. The effects of IMID were measured by the post/pre adjusted relative risk (aRR) of appropriate practice in arm B. The incremental effects of OSS were measured by the adjusted ratio of relative risks (aRRR) in arm A compared to arm B. All hypotheses were tested at a 5% level of significance.
  
  
  RESULTS
  Patient samples were comparable across arms at baseline and endline. The majority of children were aged under five years; 84% at baseline and 97% at endline. The effects of IMID on patient history (aRR = 1.12; 95% CI = 1.04-1.21) and physical examination (aRR = 1.40; 95% CI = 1.16-1.68) tasks were statistically significant. OSS was associated with incremental improvement in patient history (aRRR = 1.18; 95% CI = 1.06-1.31), and physical examination (aRRR = 1.27; 95% CI = 1.02-1.59) tasks. Improvements in laboratory testing, diagnosis, treatment, and patient/caregiver education were not statistically significant.
  
  
  CONCLUSIONS
  IMID training was associated with improved patient history taking and physical examination, and OSS further improved these clinical practices. On-site training and continuous quality improvement activities support transfer of learning to practice among mid-level practitioners.
authors: Accordia Global Health Foundation, Washington, DC, USA. imani9p@yahoo.com.|International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, USA. imani9p@yahoo.com.|Department of Pediatrics-Renal Section, Baylor College of Medicine, Houston, USA. imani9p@yahoo.com.
authors: Peace
authors: P
authors: Imani
authors: Infectious Disease Institute, Department of Medicine, Makerere University, Kampala, Uganda. bjakech@idi.org.
authors: Brian
authors: B
authors: Jakech
authors: Elizabeth Glaser Pediatric AIDS Foundation, Kampala, Uganda. ibrakiru@yahoo.co.uk.
authors: Ibrahim
authors: I
authors: Kirunda
authors: Infectious Disease Institute, Department of Medicine, Makerere University, Kampala, Uganda. mbonye@yahoo.com.|Departments of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium. mbonye@yahoo.com.
authors: Martin K
authors: MK
authors: Mbonye
authors: Infectious Disease Institute, Department of Medicine, Makerere University, Kampala, Uganda. naikobasarae@gmail.com.|Departments of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium. naikobasarae@gmail.com.
authors: Sarah
authors: S
authors: Naikoba
authors: International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, USA. mweaver@u.washington.edu.
authors: Marcia R
authors: MR
authors: Weaver
mesh_terms: D000488:Allied Health Personnel / Q000191:economics / Q000193:education*; D057191:Capacity Building; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D004506:Education, Nursing / Q000379:methods; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000592:standards*; D007239:Infections / Q000175:diagnosis* / Q000188:drug therapy*; D008487:Medical History Taking / Q000592:standards; D008880:Midwifery / Q000193:education; D010353:Patient Education as Topic; D010808:Physical Examination / Q000592:standards; D058996:Quality Improvement; D014454:Uganda