Effectiveness of peer supervision on appropriate treatment of non-bloody diarrhoea
The results show that peer supervision did not improve appropriate non-bloody diarrhoea treatment in children in the intervention district compared to the comparison district.
This is because in both districts, drug sellers prescribed more ORS and not Zinc and yet they should have prescribed the two as a combination. These study results are in agreement with what Agnes Nanyonjo et al., found while seeking to understand the impact of the iCCM strategy on uptake of appropriate diarrhoea and pneumonia treatment in Uganda42. In her study, she points to the fact that this behaviour is driven more by poverty levels of the population. The East-Central region is one of the poorest regions in Uganda43. Nevertheless, there is need to discourage the sale of zinc and ORS as separate entities because this seems to hype inappropriate treatment of non-bloody diarrhoea. Drug sellers need to be encouraged to stock and prescribe co-packaged ORS and zinc since evidence shows that a combination improves adherence to and appropriate treatment of non-bloody diarrhoea in children under five years of age44,45.
Study limitations
In order to obtain valid results for all the three outcomes (pneumonia symptoms, uncomplicated malaria and non-bloody diarrhoea), the investigators ought to have found a district that was comparable to Luuka (the intervention district) both at the baseline average (Z) and the baseline trend (ZTt) before peer supervision was introduced. However, baseline average and trend was done for uncomplicated malaria only. This may have affected the results presented in this paper.
Appropriate treatment of children less than five years with symptoms of pneumonia, uncomplicated malaria and non-bloody diarrhoea is done with reference to the child’s age. In many rural settings, a record of the child’s birth date is not accurately recorded. Therefore the investigators of this study feel that since appropriate treatment is based on age, this may have affected the results.
Policy implications
The national professional guidelines for licensing, renewal and new licenses for class C drug shops in Uganda stipulate that licensed drug sellers are responsible for supervising drug shops16. This may be one of the reasons contributing to persistent inappropriate treatment of children less than five years of age by drug sellers since their primary business motive is profit. Peer supervision may be an effective method of improving appropriate treatment of children aged five years or less with febrile illnesses.
Areas for more research
The researchers feel that while effectiveness of peer supervision on appropriate treatment among drug sellers has been assessed at aggregate district level, it is still not clear whether prescribed drugs are given to children in right doses by care givers after they have been dispensed by drug sellers. There is need for more research to understand what happens at household level.