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Job Aids Improve Patient Adherence to Treatment of Pneumonia in Niger

by Cynthia F. Young, Senior Staff Writer

In this image, the mother prepares the antibiotic tablet by crushing it with a spoon and mixing it with clean water. Artist:  Mahamadou Nadéré


Wendy Edson, PhD, RN, Senior QA Advisor in the Operations Research division of the QA Project, recently led a study to develop and evaluate the effectiveness of job aids to improve caretaker compliance in treating children with pneumonia in Niger.

The study, which took place from September 2000 to April 2001, sought to increase adherence to antibiotic therapy for pneumonia. Two strategies to curb the development of antimicrobial resistance are improving patient counseling and improving antibotic regimen adherence. Working with a team of regional healthcare professionals, the QA Project developed a package of job aids for caretakers of children, primarily mothers, and healthcare workers at clinics in Boboye District, Niger.

The team of Dr. Maina Boucar, MD, MPH, Regional Director for West Africa, Peggy Koniz-Booher, Behavior Change Communication Specialist, Sabou Djbrina, Associate Director for West Africa, and Ibrahima Mahamane, Research Coordinator, worked in collaboration with the Niger Ministry of Public Health to develop the package of job aids.

In this job aid, the mother gives the child the medication with a spoon. The father is also involved in caring for the child.   Artist:  Mahamadou Nadéré


"One of the nice things about this study was that it was a great collaboration between the research team and the program team," Dr. Edson said. "We learned from each other and the result was an appropriately designed intervention, which we then put to a rigorous test."

Formative research was conducted with healthcare workers, focus groups of men and women, observation of caretakers in the home and key informant interviews. Results of the research were used to develop messages and images for the job aids that were then pretested with caretakers and healthcare workers.

Storing the medication out of children's reach. 
Artist:  Mahamadou Nadéré


The job aids consisted of a medication envelope, counseling card, and poster for caretakers and health workers. Low cost packaging of oral cotrimoxazole was designed to depict the antibiotic regimen (dose, frequency and number of days). Four images of mothers giving their child the antibiotic were drawn by a local artist, Mahamadou Nadéré, to convey messages on proper administration, storage, and completion of the entire 5-day course. These images were combined in a counseling card and poster for the health worker. The Niger Ministry of Public Health developed a training program for health workers on interpersonal communication and use of the envelopes, counseling card, and poster.

An empty medicine package, and a well child shows that the patient must finish all of the medicine.
Artist:  Mahamadou Nadéré


The effectiveness of the job aids was tested with an experimental study design of four control sites and four experimental sites. The intervention, use of the job aids, occurred in the experimental sites where healthcare workers had a short course on interpersonal communication and use of the job aids.

Results showed increased adherence to the antibiotic regimen in the experimental sites (where the job aids were implemented). More caretakers in the experimental group mixed the tablet with clean water, stored the medicine out of the reach of children, kept follow-up appointments, and perceived that the child’s health had improved completely. The team will further analyze the effect of the health workers on adherence. (Posted August 28, 2001)

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The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development
(USAID) under Contract Number GPH-C-00-02-00004-00.