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.