Assessing the Effect of Strengthening Referral of Sick Children From the Private Health Sector and Its Impact on Referral Uptake in Uganda.

NCT02450630 | Unknown DMC

• 1 other identifier: 2000004199
• Study Type: interventional
• Target: 8,910
• Locations: 0 countries
• Sites: N/A

Brief Summary

Uganda's under-five mortality is high, currently estimated at 90/1000 live births (Uganda Bureau of Statistics 2011). Poor referral of sick children that seek care from the private sector is one of the contributory factors. The proposed intervention aims to improve uptake of referral advice for children that seek care from private facilities (registered drug shops/private clinics). The project will be implemented in Mukono district, central Uganda selected because a recent concluded trial in the district showed that drug shop vendors (DSVs) adhere to diagnostic test results, treat appropriately and refer sick children; although uptake of referral is poor. The main reasons attributed to the observed poor referral were negative attitude towards referral forms from drugs shops by the health workers at referral facilities,perceptions of poor quality of care at referral facilities and costs involved (Hutchinson. 2012; Hutchinson et al. 2013 in press).. Thus the proposed project is a follow up to address these factors with the aim to improve uptake of referral. This project is in line with the Uganda's Health sector and USAID Mission's health priorities of strengthening the health system. Critical barriers in the implementation of child survival interventions are poor quality of care in the private sector and timely referral and uptake of referral advice at community level. These barriers may be attributed to inadequate training of providers in the private sector (in diagnosis and management of childhood illnesses); inadequate supervision and regulation; poor linkages and collaboration between the public and private sectors; and non-existent linkages between community structures and the private sector. The barriers will be addressed through an intervention with three components; i) VHTs will be trained to do community sensitization and initiate community discussions aimed at identifying community support mechanisms for financial hardship (to be community led and managed) - e.g. communities to be encouraged to establish community credit/insurance schemes for referral VHTs will register children and facilitate follow up of sick children ii) supervision of providers in the private sector to diagnose, treat and refer sick children, iii) regular meetings between the public and private providers (convened by the district health team) to discuss the referral system.

Conditions

Malaria

Outcome Measures

Primary Outcomes (1)

• The proportion of sick children referred from the private sector that complete the referral process (seen at higher level facilities).

  This will be measured as a proportion of referred sick children of the total number of sick children

  2 years

Secondary Outcomes (3)

• The proportion of sick children seeking care and receiving prompt treatment at private outlets within 24 hours of onset of symptoms;

  2 years

• The time between consultations at private outlets and uptake of referral at health facilities (referral facilities);

  2 years

• The cost-effectiveness of the intervention

  2years

Study Arms (2)

training on diagnosis, treatment and referral of children

EXPERIMENTAL

Intervention Arm : training in diagnosis, treatment and referral of sick children

Behavioral: Strenghtened referral of children

Presumptive treament of sick children

NO INTERVENTION

Control Arm - Training of private providers in completing study tools i.e. filling in register and referral forms. No training in diagnosis, treatment and referral and no community awareness on referral

Interventions

Strenghtened referral of children BEHAVIORAL

Community awareness on referral+ trained private providers in using RDTs/ICCM to treat and refer sick children + supervision and regular meetings between the private and public sector.All health workers in the intervention arm will be trained on how to recognize and distinguish uncomplicated \& severe malaria, supplying unit-dose packaged Coartem® to customers with uncomplicated malaria, and administration of rectal artesunate pre-referral treatment and referral for sick children with severe and complicated malaria, diarrhoea and pneumonia.Private outlets in intervention arm will be trained to improve diagnosis, treatment and referral of children. The intervention will thus contribute to better health seeking practices at a community level and improved quality of care in the private sector

Also known as: Improved referral of sick children

training on diagnosis, treatment and referral of children

Eligibility Criteria

• Age: Up to 5 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• A cluster is defined to be a parish or neighboring parishes if the distance between any two private outlets located in each of the parishes is\<1 km( to minimize possible spill over).
• Any of the 63 parishes/clusters in Mukono district will be eligible if:
• i) Contain more than 200 households to ensure a sufficient number of sick children visiting the private outlets
• ii) Contained at least one registered drug shop/private clinic with the district drug inspector (DDI).
• iii) Contain a health centre II, the lowest public health facility where early treatment is sought.

You may not qualify if:

• i) Unregistered drug shop/private clinic
• ii) No HFII government health facility located within the same parish
• iii) Fewer than 200 households in the parish where drug shop/private clinic is located
• iv) If the health facility does not have a qualified health worker. Some government health HCIIs in Uganda are run by nursing aides.

Sponsors & Collaborators

• Ministry of Health, Uganda: lead
• Makerere University: collaborator
• Columbia University: collaborator
• London School of Hygiene and Tropical Medicine: collaborator
• University of Copenhagen: collaborator

Related Publications (2)

• Mbonye AK, Buregyeya E, Rutebemberwa E, Lal S, Clarke SE, Hansen KS, Magnussen P, LaRussa P. Treatment of Sick Children Seeking Care in the Private Health Sector in Uganda: A Cluster Randomized Trial. Am J Trop Med Hyg. 2020 Mar;102(3):658-666. doi: 10.4269/ajtmh.19-0367.

  PMID: 31971139 DERIVED

• Buregyeya E, Rutebemberwa E, LaRussa P, Mbonye A. Strengthening referral of sick children from the private health sector and its impact on referral uptake in Uganda: a cluster randomized controlled trial protocol. BMC Health Serv Res. 2016 Nov 11;16(1):646. doi: 10.1186/s12913-016-1885-5.

  PMID: 27835980 DERIVED

MeSH Terms

Conditions

Malaria

Condition Hierarchy (Ancestors)

Protozoan Infections; Parasitic Diseases; Infections; Mosquito-Borne Diseases; Vector Borne Diseases

Study Officials

• Anthony K Mbonye, PhD

  Minstry of Health Uganda

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Anthony K Mbonye, PhD

CONTACT

+256772411668; akmbonye@yahoo.com

Esther Buregyeya, PhD

CONTACT

+256704939242; eburegyeya@musph.ac.ug

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Director Health Servces in charge of community and clinical services

Study Record Dates

• First Submitted: May 9, 2015
• First Posted: May 21, 2015
• Study Start: May 1, 2015
• Primary Completion: December 1, 2016
• Study Completion: May 1, 2017
• Last Updated: May 21, 2015

Record last verified: 2015-05