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Improving adherence to cotrimoxazole for the treatment of childhood pneumonia in Niger.

Edson W | Boucar M | Djbrina S | Mahamane I | Ware HW
Organization: Quality Assurance Project/URC

Region and Country: Africa, Sub Saharan, Niger


The development of antimicrobial resistance (AMR) has increased the worldwide threat of infectious disease. Strategies to curb such development include improving (a) patient counseling and (b) adherence to the antibiotic regimen. This study tested the effect of job aids for health workers and caretakers and training for health workers in interpersonal communication (IPC) on adherence to an antibiotic regimen for the treatment of childhood pneumonia in Niger. Niger’s IMCI (Integrated Management of Childhood Illnesses) policy stipulates that children with pneumonia should receive two doses of cotrimoxazole each day for five days; the dosage is half an adult pill for infants from three to 11 months and an entire adult pill for children one to five years old. Cotrimoxazole has to be stored out of reach of children and in a dry place, and it should be crushed and dissolved in clean water for administration to the child. In addition, the full course of pills must be fully consumed and the child should have a follow-up visit at the clinic. Broad adherence to the regimen is expected to reduce AMR. We conducted a quasi-experimental study with a nonrandom assignment of eight clinics into either a program or control group. After training in IPC and the use of job aids, nurses in the four program clinics used the job aids—a counseling card, poster, and medication envelopes— while counseling the caretakers (usually mothers) of children with pneumonia. Nurses at the four control clinics initially received neither the training nor job aids but did so after the first round of data collection. The study included 675 cases: 348 in the program and 327 in the control group. To measure nurses’ medication counseling and IPC skills, we observed each nurse twice during the study. To measure caretaker adherence to the regimen, we visited caretakers’ homes four or five days after the clinic visit and talked to the caretakers. We counted the remaining pills to be able to compare actual consumption against the nationally prescribed consumption. (author's)