Category Archives: Uganda

PLOS ONE Publishes IDCAP Facility Performance Results

The International Training and Education Center for Health (I-TECH) is proud to have been a partner on the first randomized trial of educational outreach and continuous quality improvement (CQI) in Africa. The evidence in a new IDCAP Overview article published in PLOS ONE — “Improving Facility Performance in Infectious Disease Care in Uganda: a Mixed Design Study with Pre/Post and Cluster Randomized Trial Components” — by Dr. Marcia Weaver et al. supports I-TECH’s work in three ways:

  1. The pre/post comparisons showed that high quality training, educational outreach, and CQI significantly improved the quality of care for emergencies, malaria, and pneumonia, and enrollment in HIV care.
  1. IDCAP demonstrates I-TECH’s capacity to measure the effects of training and other interventions to improve care and treatment, such as case scenarios/clinical vignettes, clinical observation, facility performance measures, and population-based mortality.
  1. The Overview article reports that efforts to improve data collection had an independent effect on the quality of care for two facility performance indicators. In other words, improving health information systems also serves as an intervention to improve the quality of care. 

“I am grateful for the curriculum development ‘dream team,'” said Dr. Weaver, “including Ann Miceli and Lisa Rayko Farrar from I-TECH, for outstanding implementation by the Infectious Diseases Institute and University Research Co, LLC, and to Accordia Global Health Foundation for project leadership and Sarah Burnett’s excellent data management and analysis.”

The following recap was first published in AccordiaNews, Aug. 26, 2014. 

In a new paper, published today, Professor Marcia Weaver and colleagues report an overview of the findings from the Integrated Infectious Disease Capacity-Building Evaluation (IDCAP).

Accordia Global Health Foundation, with funding from the Bill & Melinda Gates Foundation, launched IDCAP to better equip mid-level practitioners to manage infectious diseases and to advance the global health community’s understanding of the cost-effectiveness of innovative training approaches. IDCAP created a state-of-the-art package of training interventions that incorporated three key elements: 1) a focus on mid-level practitioners, 2) integration across infectious diseases, and 3) on-site support.

The impact of training was tested on three levels: individual clinician capacity and practice, facility performance, and patient health outcomes. Professor Weaver’s article, entitled Improving Facility Performance in Infectious Disease Care in Uganda: a Mixed Design Study with Pre/Post and Cluster Randomized Trial Components, describes the impact of the IDCAP interventions on 23 facility performance indicators.

IDCAP improved the quality of care in several areas with a combination of infectious disease training, on-site team training and mentoring, and quality improvement interventions. The IDCAP interventions resulted in statistically significant improvements in six facility performance indicators related to emergency triage, assessment and treatment (ETAT), malaria diagnosis and treatment, pneumonia assessment, and enrollment in HIV care. However, the on-site support intervention alone, significantly improved performance in only one of the 23 facility indicators.

Kelly Willis, Accordia’s Executive Director and a co-author, explained, “The majority of research in medicine and public health focuses on a single disease and a single outcome, which is often appropriate.  This vertical focus however, may sometimes be to the detriment of professional training and processes of care at a clinic. Accordia is proud to be at the forefront of exploring the integration of training and clinical care.”

New Article Examines Effect of Training Approaches on Malaria Case Management

Martin Mbonye

Martin Mbonye

In Uganda, the country with the world’s highest malaria transmission rate, effective training of frontline health workers is especially critical. A new article reports the positive effects of the Integrated Infectious Disease Capacity Building Evaluation (IDCAP)’s training approaches on malaria case management in the country.

“Effect of Integrated Capacity-Building Interventions on Malaria Case Management by Health Professionals in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components” was lead-authored by Martin K. Mbonye, Msc., a researcher at the Infectious Diseases Institute (IDI) in Kampala, Uganda, and published in open-access journal PLOS ONE on Jan. 8; the full text is available online.

“This project made huge strides toward improving the capacity of health workers,” said Mbonye. “These findings have positive implications for Uganda’s increasing ability to take ownership of its malaria interventions and better fight infectious diseases – which account for the majority of the disease burden in the country.”

The IDCAP provided classroom training, distance learning, and on-site support to mid-level practitioners through two interventions: the Integrated Management of Infectious Disease (IMID) training program and on-site support, which integrated site visits and continuous quality improvement. Building on the work of the Joint Uganda Malaria Program (JUMP), IDCAP tackled a wider scope, including malaria, pneumonia, tuberculosis, HIV, and related infectious diseases. (Read more about the interventions and other results here.)

The evaluators then measured the effects of the interventions and the performance of 36 facilities. The results were promising; the combination of interventions was found to improve emergency triage, assessment and treatment processes, and malaria care, a topic of particular importance in Uganda, where steady temperatures and rainfall enable high levels of malaria transmission year-round.

As the IDCAP’s monitoring and evaluation team specialist, and then as program manager, Mbonye oversaw the project’s data surveillance system. He reported improvements in the use of diagnostic tests for malaria suspects, the prescription of the appropriate antimalarials for patients who were determined to need one, and a reduction in the prescription of antimalarials among patients who tested negative for malaria. This decrease in presumptive diagnosis is an important element in reducing drug stockouts and resistance.

I-TECH was one of four partners in the now-completed IDCAP grant to the Accordia Global Health Foundation, and University of Washington professor Marcia Weaver is the IDCAP principal investigator. This article is one of the first in a series of papers describing the study’s results.