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Cycle 1

Principal Investigator:  Anthony Mbonye, Makerere University School of Public Health
NIH-Supported Collaborator: Philip LaRussa, Columbia University
Title of NIH Award: Enhancing Training, Research Capacity and Expertise in HIV Care (ENTREE)

1-54 Training

Project Overview

Uganda’s under-five mortality is high, currently estimated at 90/1000 live births. Poor referral of sick children that seek care from the private sector is one of the contributory factors. The proposed intervention aims to improve timely referral and uptake of referral advice of children that seek care from private facilities. The private sector in this project will include private clinics and registered drug shops. The project will be implemented in Mukono district, central Uganda. This region was 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). This project is a follow up to address these factors with the aim to improve uptake of referral. The primary objective of the project is to assess the effect of strengthening the referral system on timely uptake of referral of sick children who seek care in the private sector. The secondary objectives are: 1) to assess appropriate case management for malaria, pneumonia and diarrhea; 2) to explore factors which influence the referral or non-referral of sick children from the private sector; and 3) to assess the cost effectiveness of uptake of referral of sick children who seek care in the private sector. A cluster randomized design will be applied to test the intervention in Mukono District, Central Uganda. In the intervention arm, village health teams will sensitize communities on the importance of referral. Private outlets in both arms will be trained to diagnose, treat, and refer children. The proposed intervention will have three components: i) village health trainers (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) ii) training and 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. The data generated from this study will contribute to an understanding of factors of importance for strengthening the referral system, including optimal training required, supervision activities, community participation and the costs involved. The lessons learned are likely to inform programming at a national and district level to improve referral of children from the private sector.

Summary of Recent Activities: 

During the October-December 2016 reporting period, the team continued with data collection and entry of patient consultations and referrals into the project database. The team has continued to collect and enter data on patient consultations and referrals enrolling 4,250 participants in the control arm and 5,300 in the intervention arm. Finally, research members have started designing a proposal for the project evaluation component of the PEER study.

Health Cycle 1 Recipients