Feasibility and effectiveness of peer supervision on paediatric fever treatment among registered private drug sellers in east-central Uganda
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Background: In sub-Saharan Africa, pneumonia, malaria and diarrhoea together account for about 60% of under-5 mortality within the age group 1-59 months. In Uganda, 59% of children less than five years of age with febrile illness first seek care from private health providers including drug shops. The drug sellers in these drug shops have in many instances gone beyond their role of selling drugs against prescription, to examining and prescribing treatment for sick children. However, most drug sellers are neither trained nor supervised for such clinical tasks. Meanwhile, the District Drug Inspectors (DDIs) who are mandated to inspect drug shops focus their inspections on drug storage and certification rather than clinical management. This study determined the feasibility and effectiveness of introducing a novel peer supervision on paediatric fever treatment among registered private drug sellers in East-central Uganda. Methods: A quasi-experimental study design was adopted for this research study. A two phased approach was used to answer the research questions. In the formative phase, an appraisal of the current methods of inspecting drug sellers was done and compared with national professional guidelines for licensing and renewal of class C drug shops in Uganda. Six inspectors and 100 drug sellers participated in the study. This was followed by constructing a model for a peer supervisor to augment the current inspection of drug sellers at district level. In the Evaluation phase, the effectiveness of peer-supervision among 136 drug sellers on appropriate treatment of pneumonia symptoms, uncomplicated malaria and non-bloody diarrhoea among children less than five years of age was carried out. Interrupted time series analysis was used to analyse the collected data. Finally, an assessment of experiences of drug sellers and peer supervisors at the end of the peer supervision intervention was done. Qualitative data was analysed through coding and thematic analysis while interrupted time series analysis was conducted for quantitative data. Results: The study revealed that inspection was irregular, passive, harsh and riddled with tacit solicitation of funds from drug sellers. Implementation of a constructed peer supervision model among drug sellers resulted into a 10% improvement in appropriate treatment of pneumonia symptoms among children under five years of age. Peer supervision did not have any effect on appropriate treatment of children with uncomplicated malaria symptoms and non-bloody diarrhoea. In sum, drug sellers felt that peer supervision was more reliable, more frequent and gave drug sellers an opportunity to share complex case experiences with their peer supervisors. This improved the confidence of drug sellers in e.g. using rapid diagnostic tests / Drug sellers experienced a growth in clientele and business profit. Discussion: This trial will inform the supervision part of the integrated community case management (ICCM) strategy for the private sector, thereby informing scale up in Uganda and beyond.