{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:31Z","timestamp":1787022091251,"version":"build-2736575974"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T00:00:00Z","timestamp":1634688000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Makerere -SIDA project","award":["SE-0-SE-6-5118006001-UGA-43082"],"award-info":[{"award-number":["SE-0-SE-6-5118006001-UGA-43082"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low-level private health facilities (LLPHFs) handle a considerable magnitude of sick children in low-resource countries. We assessed capacity of LLPHFs to manage malaria, pneumonia, diarrhea, and, possible severe bacterial infections (PSBIs) in under-five-year-olds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional survey in 110 LLPHFs and 129 health workers in Mbarara District, Uganda between May and December 2019. Structured questionnaires and observation forms were used to collect data on availability of treatment guidelines, vital medicines, diagnostics, and equipment; health worker qualifications; and knowledge of management of common childhood infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Amoxicillin was available in 97%, parental ampicillin and gentamicin in 77%, zinc tablets and oral rehydration salts in &gt;90% while artemether-lumefantrine was available in 96% of LLPHF. About 66% of facilities stocked loperamide, a drug contraindicated in the management of diarrhoea in children. Malaria rapid diagnostic tests and microscopes were available in 86% of the facilities, timers\/clocks in 57% but only 19% of the facilities had weighing scales and 6% stocked oxygen. Only 4% of the LLPHF had integrated management of childhood illness (IMCI) booklets and algorithm charts for management of common childhood illnesses. Of the 129 health workers, 52% were certificate nurses\/midwives and (26% diploma nurses\/clinical officers; 57% scored averagely for knowledge on management of common childhood illnesses. More than a quarter (38%) of nursing assistants had low knowledge scores. No notable significant differences existed between rural and urban LLPHFs in most parameters assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Vital first-line medicines for treatment of common childhood illnesses were available in most of the LLPHFs but majority lacked clinical guidelines and very few had oxygen. Majority of health workers had low to average knowledge on management of the common childhood illnesses. There is need for innovative knowledge raising interventions in LLPHFs including refresher trainings, peer support supervision and provision of job aides.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0257851","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T23:42:21Z","timestamp":1634773341000},"page":"e0257851","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6738-477X","authenticated-orcid":true,"given":"Juliet","family":"Mwanga-Amumpaire","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Ndeezi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"K\u00e4llander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celestino","family":"Obua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1709-9521","authenticated-orcid":true,"given":"Richard","family":"Migisha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juvenal","family":"Nkeramahame","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"St\u00e5lsby Lundborg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan Nakayaga","family":"Kalyango","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Alfv\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,10,20]]},"reference":[{"issue":"7","key":"pone.0257851.ref001","doi-asserted-by":"crossref","first-page":"537","DOI":"10.2471\/BLT.16.187476","article-title":"Strengthening health systems for universal health coverage and sustainable development","volume":"95","author":"MP Kieny","year":"2017","journal-title":"Bulletin of the World Health Organization"},{"key":"pone.0257851.ref002","volume-title":"Heath in 2015 from millennium development goals to sustainable development goals","author":"World Health Organisation","year":"2015"},{"key":"pone.0257851.ref003","doi-asserted-by":"crossref","first-page":"102","DOI":"10.3389\/fpubh.2019.00102","article-title":"Universal Health Coverage and Facilitation of Equitable Access to Care in Africa","volume":"7","author":"NdA Sanogo","year":"2019","journal-title":"Front Public Health"},{"key":"pone.0257851.ref004","volume-title":"Levels and trends in child mortality 2020, Estimates developed by the UN Inter-agency group for child mortality estimation","author":"UNICEF, WHO, World Bank Group, United Nations","year":"2020"},{"key":"pone.0257851.ref005","unstructured":"World Health Organization. World health statistics 2016: monitoring health for the SDGs sustainable development goals: World Health Organization; 2016."},{"key":"pone.0257851.ref006","unstructured":"United Nations Children\u2019s Fund. UNICEF data: Monitoring the situation of children and women; Trends in under-five mortality rate. In: UNICEF, editor. 2018."},{"key":"pone.0257851.ref007","volume-title":"Uganda Demographic and Health Survey 2016","author":"Uganda Bureau of Statistics (UBOS) and ICF","year":"2018"},{"key":"pone.0257851.ref008","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1186\/1471-2458-14-314","article-title":"Two year mortality and associated factors in a cohort of children from rural Uganda","volume":"14","author":"P Nabongo","year":"2014","journal-title":"BMC Public Health"},{"key":"pone.0257851.ref009","doi-asserted-by":"crossref","first-page":"e00089","DOI":"10.1016\/j.parepi.2019.e00089","article-title":"The effects and contribution of childhood diseases on the geographical distribution of all-cause under-five mortality in Uganda","volume":"5","author":"BB Nambuusi","year":"2019","journal-title":"Parasite epidemiology and control"},{"issue":"9963","key":"pone.0257851.ref010","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0140-6736(14)61682-2","article-title":"Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990\u20132013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"385","author":"I Abubakar","year":"2015","journal-title":"Lancet"},{"issue":"5","key":"pone.0257851.ref011","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1093\/inthealth\/ihz103","article-title":"Factors associated with under-5 mortality in three disadvantaged East African districts","volume":"12","author":"KE Agho","year":"2020","journal-title":"International health"},{"key":"pone.0257851.ref012","volume-title":"Health sector development plan 2015\/16\u20132019\/20","author":"Ministry of Health Uganda","year":"2015"},{"key":"pone.0257851.ref013","volume-title":"Health Sector Strategic Plan III 2010\/11-2014\/15","author":"Ministry of Health Uganda","year":"2011"},{"key":"pone.0257851.ref014","unstructured":"Ssengooba F. Uganda\u2019s minimum health care package: rationing within the minimum? 2004."},{"key":"pone.0257851.ref015","unstructured":"Odokonyero T, Mwesigye F, Adong A, Mbowa S. Universal Health Coverage in Uganda: The critical health infrastructure, healthcare coverage and equity. 2017."},{"issue":"1","key":"pone.0257851.ref016","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1472-698X-10-29","article-title":"Private and public health care in rural areas of Uganda","volume":"10","author":"J Konde-Lule","year":"2010","journal-title":"BMC International Health and Human Rights"},{"key":"pone.0257851.ref017","article-title":"Private health care in developing countries: If it is to work, it must start from what users need","author":"AB Zwi","year":"2001","journal-title":"British Medical Journal Publishing Group"},{"issue":"1","key":"pone.0257851.ref018","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/1475-2875-8-45","article-title":"Utilization of public or private health care providers by febrile children after user fee removal in Uganda","volume":"8","author":"E Rutebemberwa","year":"2009","journal-title":"Malaria Journal"},{"key":"pone.0257851.ref019","doi-asserted-by":"crossref","first-page":"332","DOI":"10.2471\/BLT.07.049353","article-title":"Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study","volume":"86","author":"K K\u00e4llander","year":"2008","journal-title":"Bulletin of the World Health Organization"},{"key":"pone.0257851.ref020","unstructured":"Institute for Health Metrics and Evaluation (IHME). Health service provision in Uganda: assessing facility capacity, costs of care, and patient perspectives. Seattle, WA Institute for Health Metrics and Evaluation 2301 Fifth Ave., Suite 600 Seattle, WA 98121 USA; 2014 2014."},{"key":"pone.0257851.ref021","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1186\/s12936-017-1842-8","article-title":"Comparison of the capacity between public and private health facilities to manage under-five children with febrile illnesses in Uganda","volume":"16","author":"E Buregyeya","year":"2017","journal-title":"Malaria Journal"},{"issue":"5_Suppl","key":"pone.0257851.ref022","doi-asserted-by":"crossref","first-page":"92","DOI":"10.4269\/ajtmh.2012.11-0791","article-title":"Private Sector Drug Shops in Integrated Community Case Management of Malaria, Pneumonia, and Diarrhea in Children in Uganda","volume":"87","author":"P Awor","year":"2012","journal-title":"The American Journal of Tropical Medicine and Hygiene"},{"issue":"1","key":"pone.0257851.ref023","doi-asserted-by":"crossref","first-page":"24251","DOI":"10.3402\/gha.v8.24251","article-title":"Differences in essential newborn care at birth between private and public health facilities in eastern Uganda","volume":"8","author":"P Waiswa","year":"2015","journal-title":"Global Health Action"},{"issue":"1","key":"pone.0257851.ref024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-016-1529-9","article-title":"Assessing the potential of rural and urban private facilities in implementing child health interventions in Mukono district, central Uganda\u2013a cross sectional study","volume":"16","author":"E Rutebemberwa","year":"2016","journal-title":"BMC health services research"},{"issue":"6","key":"pone.0257851.ref025","doi-asserted-by":"crossref","first-page":"e691","DOI":"10.1016\/S2214-109X(18)30215-8","article-title":"Circumstances of child deaths in Mali and Uganda: a community-based confidential enquiry","volume":"6","author":"ML Willcox","year":"2018","journal-title":"The Lancet Global Health"},{"key":"pone.0257851.ref026","volume-title":"Higher Local Government Statistical Abstract, Mbarara District","author":"LG Mbarara District","year":"2009"},{"key":"pone.0257851.ref027","unstructured":"Uganda Bureau of Statistics. The national population and housing census 2014-Area specific profile series. Kampala, Uganda; 2017."},{"key":"pone.0257851.ref028","unstructured":"Uganda MoH. Health Facilities Inventory July 2012 Ministry of Health, Uganda, Health Infrastructure Division DoCS; 2012."},{"key":"pone.0257851.ref029","volume-title":"Guidelines for Designation, Establishment and Upgrading of Health Units","author":"Ministry of Health U","year":"2011"},{"key":"pone.0257851.ref030","volume-title":"Uganda clinical guidelines 2016; national guidelines for management of common conditions","author":"Ministry of Health Uganda","year":"2016"},{"key":"pone.0257851.ref031","unstructured":"WHO. Integrated Management of Childhood Illness (IMCI) http:\/\/www.who.int\/maternal_child_adolescent\/topics\/child\/imci\/en\/."},{"key":"pone.0257851.ref032","volume-title":"IMCI chart booklet","author":"World Health Organisation","year":"2014"},{"key":"pone.0257851.ref033","unstructured":"World Health Organization. Integrated Management of Childhood Illness: distance learning course2014."},{"issue":"5","key":"pone.0257851.ref034","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1177\/0253717620946111","article-title":"Designing and Conducting Knowledge, Attitude, and Practice Surveys in Psychiatry: Practical Guidance","volume":"42","author":"C Andrade","year":"2020","journal-title":"Indian Journal of Psychological Medicine"},{"issue":"1","key":"pone.0257851.ref035","first-page":"46","article-title":"Statistical analysis: internal-consistency reliability and construct validity","volume":"6","author":"S Hajjar","year":"2018","journal-title":"International Journal of Quantitative and Qualitative Research Methods"},{"issue":"15","key":"pone.0257851.ref036","doi-asserted-by":"crossref","first-page":"7742","DOI":"10.3390\/ijerph18157742","article-title":"Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda","volume":"18","author":"J Mwanga-Amumpaire","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"6","key":"pone.0257851.ref037","doi-asserted-by":"crossref","first-page":"e1003139","DOI":"10.1371\/journal.pmed.1003139","article-title":"Antibiotic prescription practices in primary care in low-and middle-income countries: A systematic review and meta-analysis","volume":"17","author":"G Sulis","year":"2020","journal-title":"PLoS medicine"},{"key":"pone.0257851.ref038","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ijid.2020.07.084","article-title":"Antibiotic use in Kenyan public hospitals: Prevalence, appropriateness and link to guideline availability","volume":"99","author":"M Maina","year":"2020","journal-title":"Int J Infect Dis"},{"issue":"1","key":"pone.0257851.ref039","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1186\/s12879-019-3899-1","article-title":"Apparent overuse of antibiotics in the management of watery diarrhoea in children in Abakaliki, Nigeria","volume":"19","author":"AM Efunshile","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"4","key":"pone.0257851.ref040","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1002\/ppul.24679","article-title":"Oxygen insecurity and mortality in resource\u2010constrained healthcare facilities in rural Kenya","volume":"55","author":"D Otiangala","year":"2020","journal-title":"Pediatr Pulmonol"},{"issue":"2","key":"pone.0257851.ref041","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1093\/tropej\/fmx033","article-title":"Oxygen availability and nursing capacity for oxygen therapy in Ugandan paediatric wards","volume":"64","author":"J Nabwire","year":"2018","journal-title":"J Trop Pediatr"},{"issue":"07","key":"pone.0257851.ref042","doi-asserted-by":"crossref","first-page":"419","DOI":"10.3855\/jidc.859","article-title":"Influenza preparedness in low-resource settings: a look at oxygen delivery in 12 African countries","volume":"4","author":"JM Belle","year":"2010","journal-title":"The Journal of Infection in Developing Countries"},{"issue":"1","key":"pone.0257851.ref043","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.09.010503","article-title":"Increasing coverage of pediatric diarrhea treatment in high-burden countries","volume":"9","author":"K Schroder","year":"2019","journal-title":"Journal of global health"},{"issue":"3","key":"pone.0257851.ref044","doi-asserted-by":"crossref","first-page":"205","DOI":"10.2190\/8PRR-9QVE-RQUH-705U","article-title":"Correct preparation and administration of oral rehydration solution: essential for safe and effective home treatment of diarrhea in Indonesia","volume":"24","author":"SE MacDonald","year":"2004","journal-title":"Int Q Community Health Educ"},{"key":"pone.0257851.ref045","unstructured":"Ministry of Health Uganda. Annual Health Sector Perfomance Report 2019\u20132020. Kampala; 2020."},{"key":"pone.0257851.ref046","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.1371\/journal.pmed.0040098","article-title":"Loperamide Therapy for Acute Diarrhea in Children: Systematic Review and Meta-Analysis","volume":"4","author":"S-T Li","year":"2007","journal-title":"PLoS medicine"},{"issue":"2","key":"pone.0257851.ref047","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11908-020-0713-6","article-title":"Acute infectious diarrhea and gastroenteritis in children","volume":"22","author":"ID Florez","year":"2020","journal-title":"Curr Infect Dis Rep"},{"issue":"11","key":"pone.0257851.ref048","doi-asserted-by":"crossref","first-page":"e0221389","DOI":"10.1371\/journal.pone.0221389","article-title":"Diagnosis and treatment of acute respiratory illness in children under five in primary care in low-, middle-, and high-income countries: A descriptive FRESH AIR study","volume":"14","author":"J Kj\u00e6rgaard","year":"2019","journal-title":"PLoS One"},{"issue":"2","key":"pone.0257851.ref049","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.trstmh.2009.07.018","article-title":"Child age or weight: difficulties related to the prescription of the right dosage of antimalarial combinations to treat children in Senegal","volume":"104","author":"A Souares","year":"2010","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"1","key":"pone.0257851.ref050","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12936-017-2066-7","article-title":"Challenges in implementing uncomplicated malaria treatment in children: a health facility survey in rural Malawi","volume":"16","author":"AN Kabaghe","year":"2017","journal-title":"Malaria journal"},{"key":"pone.0257851.ref051","doi-asserted-by":"crossref","first-page":"S78","DOI":"10.1002\/ppul.24660","article-title":"Health system challenges for improved childhood pneumonia case management in Lagos and Jigawa, Nigeria","volume":"55","author":"F Shittu","year":"2020","journal-title":"Pediatr Pulmonol"},{"issue":"1","key":"pone.0257851.ref052","doi-asserted-by":"crossref","first-page":"17","DOI":"10.15171\/ijhpm.2019.69","article-title":"Effects of Training Health Workers in Integrated Management of Childhood Illness on Quality of Care for Under-5 Children in Primary Healthcare Facilities in Afghanistan","volume":"9","author":"E Tawfiq","year":"2020","journal-title":"Int J Health Policy Manag"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0257851","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T23:43:36Z","timestamp":1634773416000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0257851"}},"subtitle":[],"editor":[{"given":"Andrea L.","family":"Conroy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,10,20]]},"references-count":52,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0257851","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,20]]}}}