Comparison district
Buyende district has a population of 323,067
persons26. The district
has one health centre level IV, six health centres level III, eleven
health centres level II and approximately 503 village health team
members. In both districts, there was at least one drug shop in every
village. The East-Central region where these two districts are located
has a very high under-five mortality ranging between 73 to 90 per 1000
live births 28.
2.3 Characteristics of participants and description of
materials
In both districts, there were 135 registered drugs shops (Luuka 60 and
Buyende 75) operated by nursing assistants, enrolled and comprehensive
nurses, midwives and clinical officers. By law, drug shops in Uganda are
authorised to sell class-C drugs (over the counter) that do not require
prescription, used for treating minor and self-limiting conditions and
are relatively safe. However, with the introduction of the iCCM strategy
in the private sector, drug sellers were allowed to prescribe and
dispense drugs for malaria (artemisinin combination therapies),
pneumonia (amoxicillin) and diarrhoea (a combination of zinc and ORS)
for children. This study was conducted among registered drug shops.
Before introduction of peer-supervision, both districts received
training on how to treat children less than five years presenting with
symptoms of pneumonia, uncomplicated malaria and non-bloody diarrhoea
based on standard treatment guidelines developed by UNICEF, MoH and
WHO27. The training was
conducted between May 2015 and May 2016 by the Clinton Health Access
Initiative (CHAI). The period between May 2016 and October 2016 was the
period before peer-supervision was introduced.
2.4 Data collection
Socio-demographic data was collected from drug sellers using a
questionnaire. Data on number of government inspection visits per drug
shop was collected on a monthly basis from both districts from drug
sellers when information on appropriate febrile treatment was being
collected. Only data on number of peer-supervision visits was collected
from the intervention district after introduction of peer supervision.
Other data collected from drug shops included: age, gender, and
qualifications of drug seller. In addition, prescription and treatment
data of the under-five children who attended the drug shops was
extracted from sick child registers line by line as is, to ensure
accurate data capture. This data included name of the child, age,
gender, care giver name, duration of symptoms, danger signs, respiratory
rate (breaths per minute), fast breathing, RDT results as well as any
other symptoms. Names of the children and care givers were given unique
identifiers and anonymised during data management, analysis and report
writing. Data was collected from the intervention and comparison
districts between June 2016 and May 2017.