Integrated management of infectious diseases; effect of capacity building interventions on Malaria Case Management in Rural Uganda

Datum: 30 oktober 2015

Locatie: University of Antwerp - Campus Drie Eiken - Building Q - Promotiezaal - Universiteitsplein - 2610 Wilrijk

Tijdstip: 18 uur

Organisatie / co-organisatie: Faculty of Medicine and Health Sciences

Promovendus: Martin Mbonye

Promotor: Prof B. Colebunders, Prof J.-P. Van geertruyden & Prof M. Weaver

Korte beschrijving: PhD defence Martin Mbonye - Faculty of Medicine and Health Sciences



Abstract

This thesis presents results of facility performance data from an improved Health Management Information System at 36 health facilities collected as part of the Integrated Infectious Diseases Capacity Building Evaluation (IDCAP) trial. IDCAP aimed to test the effects of two integrated infectious diseases interventions: (1) an Integrated Management of Infectious Disease (IMID) course based at the Infectious Diseases Institute in Kampala, and (2) on-site support (OSS) visits to facilities two days per month for nine months.

This thesis is organized into four main parts.

  • First, we describe the 'disease burden' among outpatients attending primary care clinics as diagnosed by health care workers (HCW) prior to the interventions (November 2009 to March 2010).  Over 500 illnesses were diagnosed. An infectious disease was diagnosed during 76.3% of visits, while 30% of visits resulted in multiple diagnoses. Malaria (48.3%), cough/cold (19.4%), and intestinal worms (6.6%) were the most frequent diagnoses. Less than 30% of diagnoses for whom a laboratory investigation was available had a relevant test performed, and patients with a positive test result were often not diagnosed with the disease.
     
  • Second, we report a high malaria positivity prevalence rate (36.1%) in infants aged under six months in primary care clinics. The analysis is based on data during the interventions from October 2010 to September 2011 when the quality of malaria case management was improving. In this neglected but vulnerable population, there is low compliance of HCW with malaria testing and parasite-based treatment.
     
  • Third, we report trial results on the effect of IMID and OSS interventions on malaria case management. A combination of IMID and OSS increased prescription of appropriate antimalarials and reduced prescription of antimalarials among patients with a negative malaria test result.
     
  • Fourth, we conducted a secondary analysis to investigate separately the effect of OSS on facility performance in each of the two groups of HCW with 1) IMID training and 2) without. OSS was associated with improvement in malaria case management indicators among HCW with IMID training, and with improvements in Emergency Triage, Assessment and Treatment indicators among HCW without IMID training.