Tumwikirize WA., Ekwaru JP, Mohammed K., Ogwal-Okeng JW, Aupont O. IMPACT OF FACE-TO-FACE EDUCATIONAL INTERVENTION ON IMPROVING THE MANAGEMENT OF ARI IN PRIVATE PHARMACIES AND DRUG SHOPS IN UGANDA: Tumwikirize WA., Ekwaru JP, Mohammed K., Ogwal-Okeng JW, Aupont O. INRUD Uganda and Makerere University Project supported as part of the Joint Initiative on Improving Use of Medicine under a grant from ARCH

BACKGROUND Private pharmacies and drug shops important sources of drugs in Uganda Outlets characterized by high level of inappropriate dispensing practices. Inadequate knowledge of outlet staff identified as a major contributor to such practice Face-to face educational interaction with counter attendants (C/A) believed to be amongst strategies capable of improving the practices at outlets.

OBJECTIVES General objective: Specific Objectives: To assess the impact of an educational intervention aimed at improving the management of ARI in children under-five by counter attendants at private pharmacies and drug shops in Uganda. Specific Objectives: To evaluate the impact of the intervention on:- . C/As’ assessment of child’s illness. . Their Prescribing and dispensing practices . C/As’ advices given on home care management of ARI

METHODS Quasi-experimental research design with comparison groups Survey of 191 drug outlets in Kampala District: 27 pharmacies & 164 drug shops Use of simulated clients and case scenarios of a children with either mild or severe ARI An educational intervention targeting counter attendants at the drug outlets

Practices asking about specific questions RESULTS Changes in the assessment of children with ARI at the drug outlets Types of ARI Types of questions Intervention (n=84) Control (n= 87) Group Comparison Practices asking about specific questions Pre Post Difference Sig.* MILD ARI Age of child 98.8% 93.2% 95.5% -2.3% 0.79 Duration of illness 20.2% 25% 62.2% 74.8% -7.8% 0.62 Previous medical visits 22.6% 10.7% 17.2% 19.7% -14.4% 0.08 Previous medication 50% 53.6% 41.3% 48.5% -3.6% 0.77 Presence of fever 26.2% 16.7% 13.8% 19.6% -15.3% Difficulty in breathing 4.8% 1.1% 5.7% -9.4% n/a Nature of cough 21.4% 13.1% 26.6% 27.7% 0.27 SEVERE ARI 96.5% 100% 93.8% -1.5% 75.3% 67.1% 71.6% 77.8% 0.15 11.7% 16.5% 7.4% -7.5% 0.26 54.1% 48.2% 53.1% -17.9% 0.10 28.2% 35.3% 23.5% 35.8% -5.2% 0.58 4.7% 7.1% 6.2% 3.6% 0.49 21.2% 24.7% 12.4% 32.1% -16.2% 0.04 * Significance level estimated at p-value less than 0.05

Practices dispensing a particular drug RESULTS (cont.) Changes in dispensing patterns of drugs used for ARI at the drug outlets Types of ARI Drug type Intervention (n=84) Control (n= 87) Group Comparison Practices dispensing a particular drug Pre Post Difference Sig.* MILD ARI An antibiotic 40.5% 36.9% 52.9% 47.1% 2.2% 0.75 Co-trimoxazole 23.8% 17.9% 31% 23% 2.1% 0.82 Amoxycillin 10.7% 21.4% 10.3% 18.4% 2.6% 0.65 Ampicillin 7.1% 2.4% 11.5% 3.4% 0.90 Cough syrup 59.5% 58.3% 49.4% 58.6% -10.4% 0.28 SEVERE ARI 58.8% 70.6% 55.6 79% -11.6% 0.21 17.6% 36.5% 28.4 29.6% 17.7% 0.06 25.6% 18.8% 13.6 35.8% -29% 0.00 9.4% 8.2% 11.1 7.4% 2.5% 0.70 40% 48.2% 50.6 37% 21.8% 0.05 * Significance level estimated at p-value less than 0.05

RESULTS (Cont.) Information on dispensed drugs: daily dose the only instruction. Advice for home: plenty of oral fluids was the commonest instruction for both categories of ARI, higher in the intervention gp. Advice on referral: for mild ARI more in the comparison gp., for severe ARI decreased in both gps.

SUMMARY AND CONCLUSION Assessment of the child’s illness:Inadequate for both mild and severe ARI. Treatment of ARI: not follow recommended treatment guidelines. Intervention did not result in improvement in management of ARI. Private drug outlets will remain a major source of care in Uganda. Policy implication: Combination of regulatory & educational interventions.

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