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.