Hypoxaemia prevalence and management among children and adults presenting to primary care facilities in Uganda: A prospective cohort study.

Hypoxaemia (low blood oxygen) is common among hospitalised patients, increasing the odds of death five-fold and requiring prompt detection and treatment. However, we know little about hypoxaemia prevalence in primary care and the role for pulse oximetry and oxygen therapy. This study assessed the prevalence and management of hypoxaemia at primary care facilities in Uganda. We conducted a cross sectional prevalence study and prospective cohort study of children with hypoxaemia in 30 primary care facilities in Uganda, Feb-Apr 2021. Clinical data collectors used handheld pulse oximeters to measure blood oxygen level (SpO2) of all acutely unwell children, adolescents, and adults. We followed up a cohort of children aged under 15 years with SpO2<93% by phone after 7 days to determine if the patient had attended another health facility, been admitted, or recovered. Primary outcome: proportion of children under 5 years of age with severe hypoxaemia (SpO2<90%). Secondary outcomes: severe (SpO2<90%) and moderate hypoxaemia (SpO2 90-93%) prevalence by age/sex/complaint; number of children with hypoxaemia referred, admitted and recovered. We included 1561 children U5, 935 children 5-14 years, and 3284 adolescents/adults 15+ years. Among children U5, the prevalence of severe hypoxaemia was 1.3% (95% CI 0.9 to 2.1); an additional 4.9% (3.9 to 6.1) had moderate hypoxaemia. Performing pulse oximetry according to World Health Organization guidelines exclusively on children with respiratory complaints would have missed 14% (3/21) of severe hypoxaemia and 11% (6/55) of moderate hypoxaemia. Hypoxaemia prevalence was low among children 5-14 years (0.3% severe, 1.1% moderate) and adolescents/adults 15+ years (0.1% severe, 0.5% moderate). A minority (12/27, 44%) of severely hypoxaemic patients were referred; 3 (12%) received oxygen. We followed 87 children aged under 15 years with SpO2<93%, with complete data for 61 (70%), finding low rates of referral (6/61, 10%), hospital attendance (10/61, 16%), and admission (6/61, 10%) with most (44/61, 72%) fully recovered at day 7. Barriers to referral included caregiver belief it was unnecessary (42/51, 82%), cost (8/51, 16%), and distance or lack of transport (3/51, 6%). Hypoxaemia is common among acutely unwell children under five years of age presenting to Ugandan primary care facilities. Routine pulse oximetry has potential to improve referral, management and clinical outcomes. Effectiveness, acceptability, and feasibility of pulse oximetry and oxygen therapy for primary care should be investigated in implementation trials, including economic analysis from health system and societal perspectives.

A retrospective mixed-methods evaluation of a national ORS and zinc scale-up program in Uganda between 2011 and 2016.

BACKGROUND: In Uganda, diarrhoea was the third leading cause of mortality among children under the age of five in 2010. To address this issue, the Ministry of Health (MOH) formed a national Diarrhoea and Pneumonia Coordination Committee (DPCC) in 2011. One of the objectives of the DPCC for reducing diarrhoea mortality was to increase the use of oral rehydration salts (ORS) and zinc. This study aimed to describe and evaluate efforts by the DPCC to increase ORS and zinc coverage. METHODS: We conducted a retrospective mixed-methods evaluation to describe the activities conducted under the DPCC and evaluate the extent to which the committee's goal of increasing ORS and zinc use was achieved. We conducted secondary analysis using Uganda's Demographic and Health Survey from 2011 and 2016, analyzed cross-sectional private medicine outlet surveys from 2014 and 2016, analyzed ORS and zinc distribution data from the Uganda National Medical Stores, and reviewed program documents from DPCC partners. RESULTS: Nationally, the proportion of children under five with diarrhoea treated with ORS and zinc increased from 1% (95% confidence interval (CI) = 1%, 2%) in 2011 to 30% (95% CI = 27%, 32%) in 2016. Among private medicine outlets, the adjusted odds of having any zinc in-stock was 1.5 (95% CI = 1.14, 1.97) times higher in 2016 than in 2014, and the retail price for a complete treatment (2 ORS sachets and 10 zinc tablets) declined by $0.19 (95% CI = -0.31, -0.06), or 14%. CONCLUSIONS: Use of combined ORS and zinc for treatment of diarrhoea in children under five significantly increased in Uganda during the program period. The range of activities conducted by the various members of the DPCC likely contributed to the increase in the use of combined ORS and zinc.

Does access to credit services influence availability of essential child medicines and licensing status among private medicine retail outlets in Uganda?

BACKGROUND: Despite making great progress in reducing under five mortality in the last three decades. Uganda still ranks high among countries with the highest under five mortality rates. More than a third (36%) of these deaths are caused by pneumonia (15%), malaria (12%), or diarrhea (9%). For many mothers and caregivers, private drug shops are a point of care seeking for these illnesses. However, many drug-shops, are unlicensed and do not stock essential commodities due to insufficient capital and operational funds. This study set out to understand the relationship, between access to credit services through financial loans or stock and i) availability of essential child medicines and ii) licensing status among medicine retail outlet including drug shops and pharmacies. METHODS: This was a cross-sectional study conducted between April and March 2016. The country was divided into 168 enumeration areas based on the geographical regions and household population distribution within the region; these served as the primary sampling units. Within each enumeration area, all private medicine retail outlets (drug-shops and pharmacies) that provide consultation for childhood illnesses were identified and surveyed. Data on access to credit services was collected through interviews and data on stock, through observations of shelves for Oral rehydration salts, amoxicillin dispersible tablets, amoxicillin syrup, Artemether combined therapies, and Zinc dispersible tablets. Android tablets were used for data collection and results were analyzed using STATA12. A total of 586 outlets were visited during the study, 96% were drug shops and 4% were pharmacies. RESULTS: For all five essential child medicines assessed, access to credit through financial loans or through obtaining stock on credit did not influence stock availability. Access to credit services through loans or through stock on credit was seen to influence licensing status. The odds increased by more than 50% (1.53, CI: 1.27-2) among outlets who accessed loans compared to those who hadn't and by 2 fold (2, CI: 1.03-3.8) among those who accessed stock on credit than in those who had not. CONCLUSIONS: Access to credit does not influence stock availability of essential child medicines among private medicine outlets, however, it has an effect on licensing status. In addition to further research, the provision of financing mechanisms to support the licensing processes could increase the proportion of unlicensed outlets.