Developing innovative approaches to improve treatment provision for childhood infection in peri-urban settings: A pilot study in accredited drug shops

Lead Research Organisation: London School of Hygiene & Tropical Medicine
Department Name: Infectious and Tropical Diseases

Abstract

Pneumonia, malaria and diarrhoea are major causes of death in African children under 5 years of age, yet if diagnosis and treatment are available the majority of these deaths can be prevented. Children with these diseases should be seen and treated within 24 hours of becoming ill but affordable diagnosis and treatment are often not available close to home. Patients who do seek help often do so from retailers who sell medicines but do not provide diagnosis. In these situations, many children with serious diseases either receive the wrong treatment or the severity of their illness goes unrecognised. A simple solution, called integrated Community Case Management (iCCM), has shown encouraging results in improving diagnosis and treatment of these diseases when it is used by community health workers (volunteers who provide health services) in rural areas.

The iCCM strategy has not been tested in urban areas, but this is increasingly important because the population of African cities is expanding. Generally, this urban expansion is unplanned so living conditions and sanitation are poor, placing children at increased risk of disease. Providing better services through retail outlets is one possible way to ensure access to affordable basic health services. However, this is subject to some debate on whether retailers can provide health services of acceptable quality and price.

We plan to conduct a study in order to develop a community-based mechanism to deliver iCCM services that is suitable for urban areas. The study will be conducted in unplanned urban areas surrounding the Ugandan city of Kampala This site was chosen because it has many features of rapidly expanding cities: low socioeconomic status, unplanned housing, poor sanitation, poor provision of clean water and limited access to health services.

During the study, we shall consult with local stakeholders (local communities, drug shop vendors, health staff and national authorities) to explore which of two alternative strategies to improve access to health care in urban areas would be most feasible and acceptable to the local population and national health authorities. In these two strategies, either community health worker volunteers (CHWs) or drug shop vendors would be trained by the Ministry of Health to diagnose and treat three key childhood diseases: pneumonia, malaria and diarrhoea, and to refer patients with severe or unknown illness to local health centres. A key aim of the study is to identify the most suitable way to supervise and support community volunteers and drug shop vendors, how to integrate them into the local health system, and how to assure the quality of the services they provide.

We shall also conduct a small pilot study in 10 drug shops to measure the accuracy of diagnosis and quality of service provided after training. Drug shop vendors will be asked to record details of patients they see, including the symptoms, diagnosis and what actions were taken. This will be backed up by other methods of assessment by health professionals to assess whether the drug vendor used the iCCM guidelines and prescribed drugs correctly. The research team will also observe what happens when a sick child is treated in a drug shop, and carry out interviews to learn what providers, patients and local leaders thought of the treatments received in trained drug shops, and to explore the benefits and costs of the new approach to patients and drug shop vendors. We shall also measure how much it costs the Ministry of Health to support this approach.

The data collected will be used to inform the development of a new intervention strategy to improve access to treatment for children living in unplanned urban areas, which will be tested in future studies.

Technical Summary

Aim: To develop a health systems strategy and community-based mechanism to deliver integrated Community Case Management (iCCM) services to increase access to prompt effective treatment for childhood infections in peri-urban areas

Objectives:
i. Investigate the feasibility of two alternative community-based mechanisms (community health workers or licensed private sector drug retail outlets) to deliver iCCM in peri-urban areas
ii. Develop mechanisms for governance, quality assurance, regulation, linkage with public health system (supervision, referral, health management information system) and financial sustainability, that are acceptable to treatment providers, patients, local and national authorities and regulators
iii. Explore the acceptability and perceptions of a private sector delivery strategy amongst providers, users, national authorities and policy makers
iv. Assess quality of iCCM services provided by trained drug retailers through a small pilot study, with focus on accuracy of diagnosis and adherence to treatment guidelines

Methods: Formative research, key informant interviews, and stakeholder consultations to adapt iCCM approach and explore mechanisms to support two alternative community-based mechanisms (community health workers or drug retail outlets) to deliver iCCM services in peri-urban settings. To be followed by a small pilot study in which 10 licensed drug shops will be trained to diagnose and treat pneumonia, malaria and diarrhoea according to iCCM guidelines. The ability of drug vendors to diagnose and treat children will be evaluated through a mix of methods including: record review, clinical vignettes, participant observation, and re-assessment of a sample of patients by a qualified health worker. Participant observation and focus group discussions will explore the effects of the pilot intervention from the perspective of drug vendors, and exit interviews will examine acceptability to patients and costs incurred by households.

Planned Impact

In low income countries, malaria, pneumonia, diarrhoea and malnutrition remain major causes of under-five child mortality. In 2012, WHO/Unicef recommended integrated Community Case Management (iCCM) by community health workers as a means to increase access to health care for these preventable childhood deaths. iCCM is now accepted policy, and is currently being put into practice in health systems across the African continent. However, it has yet to reach unplanned urban areas which have rapidly expanding populations, and where use of community health workers is low. There are few studies that have examined how best to deliver services to prevent severe disease and death amongst children in these settings, and the results of this study will help fill an important gap in evidence.

By providing detailed evidence based on a multi-disciplinary approach and extensive local consultation, the study will have a beneficial impact in expanding the limited evidence base on the operational delivery of iCCM in urban settings. The study will also generate new evidence on the potential role of the private sector, which has not been widely examined. Because our study addresses a major challenge in the delivery of health services it is likely to generate high interest. Our multi-disciplinary approach will give a comprehensive assessment of quality of the medical service, costs and acceptability of the strategy, giving it a high degree of credibility.

Providing timely evidence to inform iCCM delivery in impoverished urban and peri-urban areas will have an impact in a variety of arenas.

1) Health service delivery:
The most important impact will be to provide evidence on inform the development of delivery strategies to improve access to diagnosis and treatment for the marginalised urban poor, whose estimated population will double by 2025 and encompass an estimated 50% of Africa's population.

2) Policy and strategy:
Policy makers at national, regional and international levels will be able to better assess the role of the private sector in providing care for the major childhood diseases: malaria, pneumonia and diarrhoeal disease. The evidence generated will also enable policy makers to better compare the feasibility, strengths and limitations of two alternative strategic approaches (community health workers or private sector licensed drug shops) to improve access to treatment in unplanned urban areas.

3) Changing perceptions:
By assessing evidence on the quality of service provision, the study will inform a broader debate on the role of private sector licensed drug shops in service provision, and may impact on changing perceptions of including the private sector as an active partner in the health system. This is of high relevance to Uganda and elsewhere, as there are few countries in Africa which do not share the characteristics of the study site: rapid and unplanned urban growth and gaps in public service provision filled by private providers.

4) Academia:
The research will benefit the academic community through opening up new avenues for further research in other African cities, and expanding the limited body of research on how the private sector can be harnessed to effectively advance public health goals. The cross disciplinary approach used will enhance the design and evaluation of complex public health interventions, generate novel insights, with potential to stimulate new research directions and contribute to methodological development.

In summary, this study will provide a comprehensive and timely set of evidence of relevance to both the national and global community interested in treatment provision, iCCM and child health, including major international organisations and policy makers.

Publications

10 25 50
 
Description This work revealed the size and diversity of the private health sector in African cities - even within unplanned urban slums where this study took place. We found that treatment practices for malaria in registered drug shops, pharmacies and private clinics generally conformed with national treatment guidelines, however knowledge and practice relation to the diagnosis and treatment of pneumonia was poor in all settings. Treatment of diarrhoea was also suboptimal. Future work should address these failings.
Exploitation Route Our research confirms the need for refresher training and educational materials to improve diagnosis and treatment practices amongst private providers - pharmacies, drug shops and private clinics. Recent years have witnessed an increase in public health interventions focussed on the diagnosis and treatment of malaria, including in the private sector. However our findings show that much can still be done to improve the treatment of pneumonia and diarrhoea, underlining the potential value of integrated interventions such as IMCI and iCCM (integrated Community Case Management) to improve the diagnosis and treatment of infectious diseases in children living in urban slums.
Sectors Healthcare

 
Description Findings from our research in registered drug shops In Uganda was used in informing the development of a Global Fund guidance document for Ministries of Health in malaria-endemic countries: "Technical Brief - Malaria Case Management in the Private Sector" in 2016. Our findings have fed into World Health Organization development of a Roadmap to support the use of rapid diagnostic tests in the private sector, and work undertaken other international agencies (such as Malaria Consortium, Population Services International, Clinton Health Access Initiative) to scale-up this approach in a number of other countries. In 2022, the Ministry of Health in Uganda updated policy guidance on integrated community case management (iCCM). This work, together with a number of other studies in Uganda (undertaken by other groups), has formed the body of evidence that has helped inform these developments.
First Year Of Impact 2022
Sector Healthcare
Impact Types Policy & public services

 
Description Malaria rapid diagnostic tests (RDTs) and fever case management in the private health care sector in Africa: a consultative working meeting (for the World Health Organisation)
Geographic Reach Multiple continents/international 
Policy Influence Type Contribution to a national consultation/review
URL http://www.actconsortium.org/pages/private-health-care-sector.html
 
Description Technical Brief - Malaria Case Management in the Private Sector. (Global Fund guidance document for Ministries of Health in malaria-endemic countries).
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
URL https://www.theglobalfund.org/media/5722/core_malariaprivatesector_technicalbrief_en.pdf
 
Description Understanding health system linkages: Formative research to develop strategies to support quality improvement in treatment in the private sector
Amount £200,665 (GBP)
Funding ID MR/R00370X/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 07/2017 
End 12/2020
 
Description International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Country United Kingdom 
Sector Academic/University 
PI Contribution I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual.
Collaborator Contribution The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries.
Impact This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process.
Start Year 2020
 
Description International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) 
Organisation Makerere University
Department School of Public Health
Country Uganda 
Sector Academic/University 
PI Contribution I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual.
Collaborator Contribution The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries.
Impact This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process.
Start Year 2020
 
Description International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) 
Organisation Makerere University College of Health Sciences
Country Uganda 
Sector Academic/University 
PI Contribution I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual.
Collaborator Contribution The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries.
Impact This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process.
Start Year 2020
 
Description International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) 
Organisation Royal Veterinary College (RVC)
Country United Kingdom 
Sector Academic/University 
PI Contribution I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual.
Collaborator Contribution The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries.
Impact This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process.
Start Year 2020
 
Description International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) 
Organisation Universidad Antonio Nariño
Country Colombia 
Sector Academic/University 
PI Contribution I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual.
Collaborator Contribution The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries.
Impact This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process.
Start Year 2020
 
Description International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) 
Organisation University of Glasgow
Country United Kingdom 
Sector Academic/University 
PI Contribution I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual.
Collaborator Contribution The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries.
Impact This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process.
Start Year 2020
 
Description International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) 
Organisation West Bengal University of Animal and Fishery Sciences
Country India 
Sector Academic/University 
PI Contribution I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual.
Collaborator Contribution The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries.
Impact This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process.
Start Year 2020
 
Description Research collaboration with researchers in veterinary medicine to compare antibiotic use amongst humans and animals, retail sector supply and regulatory systems for human and veterinary medicines in Uganda 
Organisation Royal Veterinary College (RVC)
Department One Health (Infectious Diseases)
Country United Kingdom 
Sector Academic/University 
PI Contribution Supervision of MSc students to support data collection in Uganda, data analysis and interpretation, and preparation of manuscripts for submission to peer-reviewed journals; Ongoing discussions to identify research priorities and funding opportunities arising from these research findings
Collaborator Contribution Joint supervision of MSc students to support data analysis and interpretation, and preparation of manuscripts for submission to peer-reviewed journals; Ongoing discussions to identify research priorities and funding opportunities arising from these research findings
Impact A poster was presented at launch of CGIAR Agriculture for Nutrition and Health Antimicrobial Resistance (AMR) Hub at the International Livestock Research Institute in Nairbi, Kenya in February 2019. https://www.cgiar.org/news-events/news/launching-today-cgiar-antimicrobial-resistance-hub A number of manuscripts are in preparation. Multidisciplinary - public health epidemiology, veterinary medicine, anthropology, chemistry (drug quality).
Start Year 2018
 
Description Research collaboration with respect to private health care providers in Uganda 
Organisation Makerere University
Country Uganda 
Sector Academic/University 
PI Contribution Intellectual input, including expertise in epidemiology, public health research, health system research, health economics, anthropology, intervention trials and research methods
Collaborator Contribution Intellectual input, including expertise in public health research, health system research, intervention trials and research methods Experience in conducting research in low-income settings New collaborations with researchers with expertise in One Health added in 2018.
Impact Hansen KS, Clarke SE, Lal S, Magnussen P & Mbonye AK. (2017) Cost-effectiveness analysis of introducing malaria diagnostic testing in drug shops: A cluster-randomised trial in Uganda. PLoS One; 12(12): e0189758. Bruxvoort KJ, Leurent B, Chandler CI, Ansah EK, Baiden F, et al. (2017) The impact of introducing malaria rapid diagnostic tests on fever case management: a synthesis of ten studies from the ACT consortium. Am J Trop Med Hyg. 97(4): 1170-1179. Hopkins H, Bruxvoort KJ, Cairns ME, Chandler CI, Leurent B, et al. (2017). Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings. BMJ; 356: j1054. Lalani M, Kitutu FE, Clarke SE & Kaur H. (2017) Antimalarial medicine quality field studies and surveys: a systematic review of screening technologies used and reporting of findings. Malaria Journal; 16(1): 197. Buregyeya E, Rutebemberwa E, LaRussa P, Lal S, Clarke SE, Hansen KS, Magnussen P & Mbonye AK. (2017). Comparison of the capacity between public and private health facilities to manage under-five children with febrile illnesses in Uganda. Malaria Journal; 16(1): 183. Mbonye AK, Buregyeya E, Rutebemberwa, E, Clarke SE, Lal S, Hansen KS, Magnussen P & LaRussa P. (2017) Referral of children seeking care at private health facilities in Uganda. Malaria Journal; 16(1): 76. Visser T, Bruxvoort K, Maloney K, Leslie T, Barat LM, et al. (2017) Introducing malaria rapid diagnostic tests in private medicine retail outlets: A systematic literature review. PLoS One; 12(3): e0173093 Burchett HE, Leurent B, Baiden F, Baltzell K, Björkman A, et al. (2017) Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence. BMJ Open; 7(3): e012973 Hutchinson E, Hutchison C, Lal S, Hansen SC, Kayendeke M, Nabirye C, Magnussen P, Clarke SE, Mbonye A, Chandler C. (2017) Introducing rapid diagnostic tests for malaria into the retail sector: What are the unintended consequences? BMJ Global Health, 2: e000067 Mbonye AK, Buregyeya E, Rutebemberwa E, Clarke SE, Lal S, Hansen KS, Magnussen P, LaRussa P. (2016) Prescription for antibiotics at drug shops and strategies to improve quality of care and patient safety: a cross-sectional survey in the private sector in Uganda. BMJ Open, 6: e010632. Rutebemberwa E, Buregyeya E, Lal S, Clarke SE, Hansen KS, Magnussen P, LaRussa P & Mbonye AK. (2016) Assessing the potential of rural and urban private facilities in implementing child health interventions in Mukono district, central Uganda-a cross sectional study. BMC Health Services Research, 16:268 Mbonye AK, Buregyeya E, Rutebemberwa E, Clarke SE, Lal S, Hansen KS, Magnussen P & LaRussa P. (2016) Treatment and prevention of malaria in pregnancy in the private health sector in Uganda: implications for patient safety. Malaria J, 15(1):212 Mbonye A, Clarke S, Lal S, Chandler C, Hutchinson E, Hansen KS & Magnussen P. (2015). Introducing rapid diagnostic tests for malaria into registered drug shops in Uganda: lessons learned and policy implications. Malaria Journal 14: 448 Hutchinson E, Chandler C, Clarke SE, Lal S, Magnussen P, Kayendeke M, Nabirye C, Kizito J & Mbonye AK. (2015) "It puts life in us and we feel big": Shifts in the local health care system during the introduction of rapid diagnostic tests for malaria into drug shops in Uganda. Critical Public Health 25 (1): 48-62 Mbonye AK, Magnussen P, Lal S, Hansen KS, Cundill B, Chandler C & Clarke SE. (2015). A cluster randomised trial introducing rapid diagnostic tests into registered drug shops in Uganda: Impact on appropriate treatment of malaria. PLoS One 10 (7): e0129545
Start Year 2015
 
Description 7th MIM Pan African Malaria Conference - Dakar, April 15-20, 2018 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Presentation at the 7th MIM Pan African Malaria Conference held in Dakar, April 2018 - an event attended by malaria researchers, National Malaria Control Program managers, World Health Organisation and other international agencies, international donors, research funders, and industry.
Year(s) Of Engagement Activity 2018