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Participatory healthcare-provider orientation to improve artemether-lumefantrine-based drug treatment of uncomplicated malaria: a cluster quasi-experimental study
  1. Norbert G Anyama1,
  2. James K Tibenderana2,
  3. Paul Kutyabami1,
  4. Pakoyo F Kamba1,
  5. Freddy E Kitutu1,
  6. Richard O Adome1
  1. 1Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
  2. 2Uganda Malaria Research Centre and Malaria Consortium, Kampala, Uganda
  1. Correspondence to Norbert G Anyama, Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda; nanyama{at}


Objectives To assess the effect of participatory healthcare-provider orientation in enhancing patient knowledge, appropriate prescribing and dispensing of artemether-lumefantrine, during drug treatment of uncomplicated malaria.

Methods A cluster quasi-experimental study. The authors developed strategies to address challenges encountered by healthcare providers during clinical management of malaria. The primary outcome was patient knowledge on prescribed malaria drug treatment. Secondary outcomes were appropriate prescribing and provision of adequate drug dispensing information. The authors used generalised estimating equation logistic regression to investigate correlates of appropriate use of artemether-lumefantrine.

Results The proportion of patients or caretakers of paediatric patients sufficiently knowledgeable about malaria treatment increased from 16/85 (18.8%) at baseline to 33/96 (34.4%) at evaluation, OR 2.26 (95% CI 1.13 to 4.49), p=0.020, in the intervention, and fell slightly from 49/134 (36.6%) to 35/114 (30.7%), OR 0.77, (95% CI 0.45 to 1.31), p=0.331 in the control district. This was enhanced by the existence of drug-dispensing standard operating procedures (adjusted OR 1.85, 95% CI 0.98 to 3.50; p=0.057). The proportion of appropriate prescriptions increased from 61/87 (70.1%) to 94/112 (83.9%) in the intervention district, OR 2.23 (95% CI 1.13 to 4.40), p=0.020 and reduced from 91/115 (79.1%) to 75/112 (67.0%) in the control district, OR 0.53, (95% CI 0.29 to 0.97), p=0.040. The frequency of adequately dispensed prescriptions increased in the intervention district (34(32.4%) to 53(45.3%), OR 1.73 (95% CI 1.00 to 2.99), p=0.050) but decreased in the control location (94 (69.6%) to 71 (52.6%), OR 0.48 (95% CI 0.29 to 0.80), p=0.004).

Conclusions Participatory healthcare-provider orientation enhanced patient knowledge, healthcare provider prescribing and dispensing of artemether-lumefantrine, bolstered by adequate medication counselling and use of drug-dispensing standard operating procedures.

  • Malaria
  • drug treatment
  • training
  • patient education
  • cluster analysis
  • drug therapy
  • quality of care
  • training

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  • Funding This study was funded by a DFID grant CNTR-04532 through the Uganda Malaria Research Centre and Malaria Consortium.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the institutional review committee of the Faculty of Medicine, Makerere University and the Uganda National Council for Science and Technology.

  • Provenance and peer review Not commissioned; externally peer reviewed.