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Effectiveness of educational outreach in infectious diseases management: a cluster randomized trial in Uganda

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dc.contributor.author Mbonye, M. K. en_US
dc.contributor.author Burnett, S. M. en_US
dc.contributor.author Naikoba, S. en_US
dc.contributor.author Ronald, A. en_US
dc.contributor.author Colebunders, R. en_US
dc.contributor.author Van geertruyden, J. P. en_US
dc.contributor.author Weaver, M. R. en_US
dc.date.accessioned 2017-12-18T12:56:03Z
dc.date.available 2017-12-18T12:56:03Z
dc.date.issued 2016 en_US
dc.identifier.issn 1471-2458 en_US
dc.identifier.doi http://dx.doi.org/10.1186/s12889-016-3375-4 en_US
dc.identifier.other http://lib.itg.be/pdf/itg/2016/2016bphe0714.pdf en_US
dc.identifier.other 14 pp. en_US
dc.identifier.other 58 en_US
dc.identifier.other ITG-C5A; DCS; U-HIVCLI; JIF; DOI; PDF; PMC; OAJ; E-only; Abstract; DSPACE64 en_US
dc.identifier.uri http://hdl.handle.net/10390/9818
dc.description.abstract BACKGROUND: Integrated Infectious Diseases Capacity Building Evaluation (IDCAP) teams designed and implemented two health worker in-service training approaches: 1) an off-site classroom-based integrated management of infectious diseases (IMID) course with distance learning aspects, and 2) on-site support (OSS), an educational outreach intervention. We tested the effects of OSS on workload and 12 facility performance indicators for emergency triage assessment and treatment, HIV testing, and malaria and pneumonia case management among outpatients by two subgroups: 1) mid-level practitioners (MLP) who attended IMID training (IMID-MLP) and 2) health workers who did not (No-IMID). METHODS: Thirty-six health facilities participated in the IDCAP trial, with 18 randomly assigned to Arm A and 18 to Arm B. Two MLP in both arms received IMID. All providers at Arm A facilities received nine monthly OSS visits from April to December 2010 while Arm B did not. From November 2009 to December 2010, 777,667 outpatient visits occurred. We analyzed 669,580 (86.1 %) outpatient visits, where provider cadre was reported. Treatment was provided by 64 IMID-MLP and 1,515 No-IMID providers. The effect of OSS was measured by the difference in pre/post changes across arms after controlling for covariates (adjusted ratio of relative risks = a RRR). RESULTS: The effect of OSS on patients-per-provider-per-day (workload) among IMID-MLP (aRRR = 1.21; p = 0.48) and No-IMID (aRRR = 0.90; p = 0.44) was not statistically significant. Among IMID-MLP, OSS was effective for three indicators: malaria cases receiving an appropriate antimalarial (aRRR = 1.26, 99 % CI = 1.02-1.56), patients with negative malaria test result prescribed an antimalarial (aRRR = 0.49, 99 % CI = 0.26-0.92), and patients with acid-fast bacilli smear negative result receiving empiric treatment for acute respiratory infection (aRRR = 2.04, 99 % CI = 1.06-3.94). Among No-IMID, OSS was effective for two indicators: emergency and priority patients admitted, detained or referred (aRRR = 2.12, 99 % CI = 1.05-4.28) and emergency patients receiving at least one appropriate treatment (aRRR = 1.98, 99 % CI = 1.21-3.24). CONCLUSION: Effects of OSS on workload were not statistically significant. Significant OSS effects on facility performance across subgroups were heterogeneous. OSS supported MLP who diagnosed and treated patients to apply IMID knowledge. For other providers, OSS supported team work to manage emergency patients. This evidence on OSS effectiveness could inform interventions to improve health workers' capacity to deliver better quality infectious diseases care. en_US
dc.language English en_US
dc.relation.uri http://www.ncbi.nlm.nih.gov/pubmed/27488692 en_US
dc.subject Infectious diseases en_US
dc.subject Treatment en_US
dc.subject Education en_US
dc.subject Outreach en_US
dc.subject Uganda en_US
dc.subject Africa-East en_US
dc.title Effectiveness of educational outreach in infectious diseases management: a cluster randomized trial in Uganda en_US
dc.type Article-E en_US
dc.citation.jtitle BMC Public Health en_US
dc.citation.volume 15 en_US
dc.citation.pages 714 en_US
dc.citation.abbreviation BMC Public Health en_US


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