Amoxicillin prescription patterns and associated factors among village health teams in the ICCM program in Pallisa District, Eastern Uganda: a cross sectional study

Abstract

Background: Since 2010, reliance on VHTs to treat children with pneumonia in iCCM programs using oral amoxicillin has increased in Uganda, particularly in resource-limited settings. VHTs must use amoxicillin rationally to maximize its benefits. However, inappropriate amoxicillin prescriptions have been reported in Pallisa district. Objectives: To assess the nature of and factors associated with VHTs’ amoxicillin prescription patterns as well as explore their experiences and perceptions regarding the prescriptions in the iCCM program in Pallisa district. Methods: Between April and May 2018, a cross sectional study was conducted among 389 randomly selected VHTs in the iCCM program. Quantitative data were collected using checklist and structured questionnaire. Qualitative data were collected using FGD and KI guides. Both quantitative and qualitative data analyses were undertaken. Multivariate logistic regression analysis was performed to assess factors associated with amoxicillin prescription patterns. Qualitative data were analyzed using deductive thematic analysis approach. Results: Of the 389 VHTs sampled, 334 were included in the study. Irrational amoxicillin prescription was 87.13%. Audit and background training of VHTs were the factors associated with amoxicillin prescription. Audits improved rational amoxicillin prescription among VHTs (AOR 2.07, 95% CI 1.065-4.008). Background VHT’s training also improved rational amoxicillin prescription (AOR 3.29, 95% CI 1.047-7.444). Factors that affect amoxicillin prescription by the VHTs are; inadequate knowledge and skills to assess fast breathing and poor understanding of amoxicillin dosages, ineffective supervision, lack of refresher trainings, community outrage, lack of supplies, poor motivation of VHTs, and failure for IPs to share VHTs’ data with DHT. Conclusion: Amoxicillin prescription was associated with the audit and background training of VHTs prior to the iCCM program. Continued refresher trainings and effective supervision are urgently needed. Alongside enhanced supply of adequate respiratory timers and sensitization of the community about when to use amoxicillin, supervisors should also focus on improving VHTs’ skills in using respiratory timers and determining the correct doses of amoxicillin