Kafle 1995.
| Methods |
Study design: Cluster RCT Duration of study: October 1994 to May 1995 Unit of allocation: District (3 intervention, 3 control) Method of allocation: Random Unit of analysis: Health facilities (21 intervention, 21 control) Sampling: Multi‐stage: 3 out of 5 districts where UNICEF training was proposed were randomly selected for Intevention Group 1. 3 districts for Intervention Group 2 and 3 districts for the Control Group were randomly selected from 17 other districts. Random selection of four health facilities per district plus selection of three neighbouring sub‐health posts. |
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| Participants |
Country: Nepal Income classification: Low income Geographical scope: Terai, Nepal Rural/urban: Not explicitly specified, but probably rural (Terai) Setting: Health facilities Supervisees: Drug prescribers in health facilities Supervisors: DHOs and DPHOs Patients/clients: Not specified |
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| Interventions |
Stated purpose: To evaluate the impact of regular supervision/monitoring using a Standard Drug Treatment Schedule on prescribing patterns Description intervention 1: No intervention (assigned training for prescribers bud did not take place) Description intervention 2: Supervision visits from DHO/DPHO trained in the use of supervision tools and providing feedback. Control: No intervention Training: Supervision oriented to supervision tools and provided with guidelines on their use and giving feedback Frequency of supervisory visits: 2 supervisor visits (the first one month after the baseline and the second two months later) Co‐interventions: None |
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| Outcomes |
Primary outcomes: Prescribing practices Secondary outcomes: Prescribing knowledge Time points when outcomes measured: 7 months after baseline |
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| Notes | Funding: USAID/JSI | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | States allocation was random with no further details |
| Allocation concealment (selection bias) | Low risk | Allocation performed at start of study |
| Blinding (performance bias and detection bias) All outcomes | Unclear risk | Not stated if outcome variables were assessed blindly |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Complete follow‐up |
| Selective reporting (reporting bias) | Low risk | Authors have not reported on all three dimensions (history taking, examination, drug use) for all 8 diseases (Annex 10, page 30) |
| Other bias | Low risk | |
| Baseline outcome measurements similar? | Unclear risk | Baseline outcomes for prescribing indicators similar. No baseline for prescribing knowledge. |
| Baseline characteristics similar? | Unclear risk | No characteristics stated |
| Protection against contamination? | Low risk | Control group unlikely to have received the intervention |