Ugandan Health Facilities Improve Rational Treatment for Diarrhea and the Common Cold

Figure 1: Percentage of diarrhea cases that are appropriately treated

The MSH-led, USAID-funded Securing Ugandans’ Right to Essential Medicines (SURE) program registered significant improvements in rational prescriptions for diarrhea and cough after introducing on-the-job training to health workers. The training, which is a component of SURE’s supervision, performance assessment, and recognition strategy, was introduced in collaboration with the Ministry of Health to improve medicines availability, storage, and appropriate use.

According to a Uganda Ministry of Health pharmaceutical sector report in 2010, the number of medicines prescribed to each patient in public health facilities was 3.2, compared to 2.5 medicines prescribed in other developing countries. The report identified overprescription of antibiotics—especially for common colds—and underprescription of rehydration treatment for diarrhea as major problems.

Using an indicator-based tool to assess performance and identify areas of weakness at facilities, medicines management supervisors started training and coaching health workers on better medicine management practices, including appropriate medicines use, during each supervisory visit.

After four visits, each patient was receiving an average of 2.8 medicines per prescription. After five supervisory visits, more than half of the diagnosed diarrhea cases were being treated appropriately with oral rehydration salts, zinc, vitamin A, and without an antibiotic. This is compared with only 9 percent of the diarrhea cases that had been treated appropriately before the first supervisory visit. (See figure 1, above.)

[Figure 2: Percentage of cough/cold cases that are appropriately treated ]Figure 2: Percentage of cough/cold cases that are appropriately treated

A similar increase was also noted for appropriate cough treatment, where more than one-third of patients was appropriately treated by the fourth and fifth visits, compared to one of 16 patients recorded during the first visit. Because cough and cold are caused by viral rather than bacterial infections, antibiotics are not recommended. Proper treatment, therefore, includes paracetamol and cough/cold medicines that target symptoms. (See figure 2.)

The improvement in medicines use means that more patients are getting the medicines that are effective to treat their condition. In addition, rational use reduces the risk of adverse reactions in patients and the development of antimicrobial resistance that results from inappropriate use of antibiotics.