1. 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

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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.

9. THANK YOU FOR LISTENING