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RATIONAL USE OF ANTI-BIOTICS IN COMMUNITY
CLINICS: AN INTERVENTION AND EVALUATION
IN BANGALDESH
Rumana Huque, Helen Elsey,...
Presentation overview
 Background
 Methods
 Results
 Conclusion
Background
 Evidence (Biswas et al, 2014; Guyon et al, 1994) suggests
that:
 56% of the doctors prescribe antibiotics in...
Background
 In Bangladesh, the under-five
mortality rate remains high, at 38
per 1000.
 Access to primary care,
particul...
Level of Health Facilities
Objectives
 To promote rational use of antibiotic by
community health care providers at CCs
 To improve consultation beh...
Methodology
 Study design
 Context review and rapid assessment
 Intervention design and delivery
 Post-intervention as...
Methodology
 Setting
 40 CCs from 2 sub-districts
 Population
 all under-five children attended the CCs from August
20...
A training package including 4
new components:
1. an Integrated
Management of
Childhood Illness (IMCI) -
based job aid of ...
Approach
 Involving Ministry of Health and Family Welfare
and other stakeholders in expert group
 Embed within the exist...
Results
Rapid assessment
Severely ill children Under-fives seen
per clinic per
Month (n)
Under-fives who
received proper
diagnosis...
OUTCOME MEASURES (N = 1490) n % 95% CI
Correct diagnosis decision 1355 91 89 – 92
Correct treatment decision 1277 86 84 – ...
PRESENTING DISEASE
TOTAL
CORRECT
DIAGNOSIS
CORRECT
ANTIBIOTIC USE
CORRECT
REFERRAL
N n (%) 95% CI n (%) 95% CI n (%) 95% C...
CONSULTATION OUTCOME MEASURES n % 95% CI
Welcomed the patient 24 64 47 – 80
Encouraged the patient to talk 37 100 91 – 100...
Conclusion
 Scale up:
 Training of 1200 doctors
 14,000 CHCP
 Nationwide coverage
 Important innovation: adaptation o...
Thank you!
Rational use of antibiotics in community clinics: an intervention and evaluation in Bangladesh
Rational use of antibiotics in community clinics: an intervention and evaluation in Bangladesh
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Rational use of antibiotics in community clinics: an intervention and evaluation in Bangladesh

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A presentation given to delegates at the Health Systems Research Symposium, Vancouver, 2016 describing our work to promote rational use of antibiotics in children under 5 and improve consultation behaviour among community health care providers in Bangladesh.

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Rational use of antibiotics in community clinics: an intervention and evaluation in Bangladesh

  1. 1. RATIONAL USE OF ANTI-BIOTICS IN COMMUNITY CLINICS: AN INTERVENTION AND EVALUATION IN BANGALDESH Rumana Huque, Helen Elsey, Rebecca King et al Health Systems Research Symposium, Vancouver 16 November, 2016
  2. 2. Presentation overview  Background  Methods  Results  Conclusion
  3. 3. Background  Evidence (Biswas et al, 2014; Guyon et al, 1994) suggests that:  56% of the doctors prescribe antibiotics in suspected infection while only 33% of them prescribe antibiotics in confirmed cases.  Prescriber prescribed antibiotics to the patients mainly for cold and fever, infections, diarrhea.  40% of doctors prescribe antibiotics in cold and fever before any diagnostic test.  37% of doctors prescribe antibiotics for pleasing the patients.
  4. 4. Background  In Bangladesh, the under-five mortality rate remains high, at 38 per 1000.  Access to primary care, particularly by the poorest is a major concern.  MOHFW has planned to establish one community clinic (CC) for approximately 6,000 people to provide primary care.  About 14,000 CCs have been built.
  5. 5. Level of Health Facilities
  6. 6. Objectives  To promote rational use of antibiotic by community health care providers at CCs  To improve consultation behavior of the CHCPs
  7. 7. Methodology  Study design  Context review and rapid assessment  Intervention design and delivery  Post-intervention assessment: cross sectional survey
  8. 8. Methodology  Setting  40 CCs from 2 sub-districts  Population  all under-five children attended the CCs from August 2014 to February 2015  CHCPs who cared for them  Assessment  child aged 5 years examined  6 consecutive days in each CC  was re-assessed at exit by a SACMO  observation
  9. 9. A training package including 4 new components: 1. an Integrated Management of Childhood Illness (IMCI) - based job aid of six common illnesses 2. a ‘how to diagnose and treat’ guide to assessing the child and communicating with the child and caregiver 3. IMCI user guidelines describing how to use the IMCI job aid, and 4. training modules, including case studies and role-plays Development of the intervention and its delivery
  10. 10. Approach  Involving Ministry of Health and Family Welfare and other stakeholders in expert group  Embed within the existing health system  Skilled based interactive training  Scale up
  11. 11. Results
  12. 12. Rapid assessment Severely ill children Under-fives seen per clinic per Month (n) Under-fives who received proper diagnosis and care (%) Danger sign 3 50 Pneumonia 9 20 Diarrhoea 14 80 Total 26 56 No treatment needed 37 10 All children 63 29
  13. 13. OUTCOME MEASURES (N = 1490) n % 95% CI Correct diagnosis decision 1355 91 89 – 92 Correct treatment decision 1277 86 84 – 87 Correct used of antibiotics 1326 89 87 – 91 Among those who required antibiotics (n=106) 94 89 81 – 93 Among those who did not required antibiotics (n=1384) 1232 89 87 – 91 Correct referral decision 1483 99.5 99.0 – 99.8 Among those who required referral (n=17) 16 94 73 – 99 Among those who did not require referral (n=1473) 1467 99.6 99.1 – 99.8
  14. 14. PRESENTING DISEASE TOTAL CORRECT DIAGNOSIS CORRECT ANTIBIOTIC USE CORRECT REFERRAL N n (%) 95% CI n (%) 95% CI n (%) 95% CI No pneumonia (cough or cold) 991 919 (93) 91 – 94 849 (86) 83 – 88 990 (99) 99 – 100 Pneumonia 50 34 (68) 53 – 80 44 (88) 76 – 95 50 (100) 93 – 100 Severe Pneumonia 2 1 (50) 1 – 99 2 (100) 16 -100 2 (100) 16 – 100 Diarrhoea 107 105 (98) 93 – 100 105 (98) 93 – 100 106 (99) 95 – 100 Dysentery 27 27 (100) 87 – 100 26 (96) 81 – 100 27 (100) 87 – 100 Fever 117 104 (89) 82 - 94 112 (96) 90 - 99 117 (100) 97 - 100
  15. 15. CONSULTATION OUTCOME MEASURES n % 95% CI Welcomed the patient 24 64 47 – 80 Encouraged the patient to talk 37 100 91 – 100 Looked at the patient 37 100 91 – 100 Listened to the patient 37 100 91 – 100 Proper seating arrangement during consultation 27 73 56 – 86 Looked for danger signs of severe illness 25 68 50 – 82 Asked about symptoms 37 100 91 – 100 Started questioning using open ended questions 37 100 91 – 100 Completed questions using closed ended questions 35 95 82 – 99 Interrupted parent / carer while talking 18 49 32 – 66 Able to encourage parent / carer to describe the child’s condition 37 100 91 – 100 Look, listen and feel for the reluctant signs 36 97 86 – 100 Explaining diagnosis and treatment to the patient 24 64 47 – 80 Give preventive messages related to this illness 26 70 53 - 84
  16. 16. Conclusion  Scale up:  Training of 1200 doctors  14,000 CHCP  Nationwide coverage  Important innovation: adaptation of the IMCI to the Bangladesh context, in line with updated WHO guidance  Need supportive supervision and on-the-job training for sustaining the achievement
  17. 17. Thank you!

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