Bagonza Arthur, Kitutu Freddy Eric, Peterson Stefan, Mårtensson Andreas, Mutto Milton, Awor Phyllis, Mukanga David, Wamani Henry
Department of Community Health and Behavioural Sciences Makerere University College of Health Sciences, School of Public Health Kampala Uganda.
Department of Pharmacy, School of Health Sciences Makerere University College of Health Sciences Kampala Uganda.
Health Sci Rep. 2021 May 7;4(2):e284. doi: 10.1002/hsr2.284. eCollection 2021 Jun.
Appropriate treatment of pediatric fever in rural areas remains a challenge and maybe partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer-supervision among drug sellers on the appropriate treatment of pneumonia symptoms, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age in the intervention (Luuka) and comparison (Buyende) districts, in East-Central Uganda.
Data on pneumonia symptoms, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age was abstracted from drug shop sick child registers over a 12-month period; 6 months before and 6 months after the introduction of peer-supervision. Interrupted time series were applied to determine the effectiveness of the peer-supervision intervention on the appropriate treatment of pneumonia, uncomplicated malaria, and non-bloody diarrhea among children less than 5 years of age attending drug shops in East Central Uganda.
The proportion of children treated appropriately for pneumonia symptoms was 10.84% ( < .05, CI = [1.75, 19.9]) higher, for uncomplicated malaria was 1.46% ( = .79, CI = [-10.43, 13.36]) higher, and for non-bloody diarrhea was 4.00% ( < .05, CI = [-7.95, -0.13]) lower in the intervention district than the comparison district, respectively.Post-intervention trend results showed an increase of 1.21% ( = .008, CI = [0.36, 2.05]) in the proportion appropriately treated for pneumonia symptoms, no difference in appropriate treatment for uncomplicated malaria, and a reduction of 1% ( < .06, CI = [-1.95, 0.02]) in the proportion of children appropriately treated for non-bloody diarrhea, respectively.
Peer-supervision increased the proportion of children less than 5 years of age that received appropriate treatment for pneumonia symptoms but not for uncomplicated malaria and non-bloody diarrhea. Implementation of community-level interventions to improve pediatric fever management should consider including peer-supervision among drug sellers.
原理、目的和目标：农村地区儿童发热的恰当治疗仍然是一项挑战，这可能部分归因于对持牌药品销售商的监管不足。本研究评估了药品销售商之间的同伴监督对乌干达中东部干预地区（卢卡）和对照地区（布延德）5岁以下儿童肺炎症状、非复杂性疟疾和非血性腹泻恰当治疗的有效性。
从药店病童登记册中提取了12个月期间5岁以下儿童肺炎症状、非复杂性疟疾和非血性腹泻的数据；引入同伴监督前6个月和引入后6个月的数据。采用中断时间序列分析来确定同伴监督干预对乌干达中东部光顾药店的5岁以下儿童肺炎、非复杂性疟疾和非血性腹泻恰当治疗的有效性。
干预地区5岁以下儿童肺炎症状得到恰当治疗的比例比对照地区高10.84%（P<0.05，CI = [1.75, 19.9]），非复杂性疟疾得到恰当治疗的比例高1.46%（P = 0.79，CI = [-10.43, 13.36]），非血性腹泻得到恰当治疗的比例低4.00%（P<0.05，CI = [-7.95, -0.13]）。干预后趋势结果显示，肺炎症状得到恰当治疗的比例增加了1.21%（P = 0.008，CI = [0.36, 2.05]），非复杂性疟疾恰当治疗情况无差异，非血性腹泻得到恰当治疗的儿童比例降低了1%（P<0.06，CI = [-1.95, 0.02]）。
同伴监督提高了5岁以下儿童肺炎症状得到恰当治疗的比例，但对非复杂性疟疾和非血性腹泻的恰当治疗比例没有提高。实施社区层面的干预措施以改善儿童发热管理应考虑将药品销售商之间的同伴监督纳入其中。
