<p> ANNEX E: EXAMPLES OF STRUCTURED OBSERVATION PROTOCOLS</p><p>Example 1: Bangladesh Diarrhoea Study - Clinical Encounter Observation Form</p><p>Example 2: Bangladesh Diarrhoea Study - Dispensing Process Observation Form</p><p>Example 3: Nigeria Malaria Study - Clinical Process Observation Form</p><p>Example 4: WHO/CDD Drug Sellers Study - Pharmacy Encounter Observation Form Example 1: Bangladesh Diarrhea Study - Clinical Encounter Observation Form</p><p>IDENTIFYING INFORMATION</p><p>Health Facility: ______Dept:______Date:______</p><p>Visit ID: ______Time of Visit:______</p><p>Patient Age (yrs,mos): ______Sex:______Accompanied by: ______</p><p>PRESCRIBER-PATIENT INTERACTION</p><p>Length of Clinical Consultation (minutes): ______Provider Type: ______</p><p>DIAGNOSTIC COMMUNICATION Prescriber</p><p>Patient</p><p>Not</p><p>Asked</p><p>Volunteered</p><p>Discussed</p><p>Length of diarrhoea episode</p><p>______</p><p>______</p><p>______Association of onset with foods eaten ______</p><p>ANNEX E - 1 ______</p><p>______Diarrhoea frequency/volume</p><p>______</p><p>______</p><p>______Appearance of Stool</p><p>______</p><p>______</p><p>______Child still eating/drinking/breastfeeding ______</p><p>______</p><p>______Previous treatment for this episode</p><p>______</p><p>______</p><p>______</p><p>EXAMINATION/TREATMENT Examined Not Does Examined Not Apply</p><p>Temperature (measured or felt)</p><p>______</p><p>ANNEX E - 2 ______</p><p>______Pulse</p><p>______</p><p>______</p><p>______Skin turgor</p><p>______</p><p>______</p><p>______Fontanelle (if child under 6 months) ______</p><p>______</p><p>______Diaper examined (if soiled)</p><p>______</p><p>______</p><p>______Stool culture ordered</p><p>______</p><p>______</p><p>______Sterile technique followed for injection ______</p><p>ANNEX E - 3 ______</p><p>______</p><p>COMMUNICATION/ADVICE</p><p>Prescriber</p><p>Patient</p><p>Not Initiated</p><p>Initiated</p><p>Discussed Specific drugs/injection desired</p><p>______</p><p>______</p><p>______Information on drugs prescribed</p><p>______</p><p>______</p><p>______Eating/feeding/breastfeeding advice ______</p><p>______</p><p>______Information about diarrhoea prevention ______</p><p>______</p><p>ANNEX E - 4 ______</p><p>ANNEX E - 5 DESCRIPTION OF CLINICAL ENCOUNTER </p><p>1. Patient greets prescriber Yes ______No ______</p><p>2. Prescriber reciprocates greeting Yes ______No ______</p><p>3. Friendly conversation Yes ______No ______</p><p>4. Reassurance to the child Yes ______No ______</p><p>5. Reassurance to the adult Yes ______No ______</p><p>6. Friendly eye contact with adult Yes ______No ______</p><p>7. Encouraged to describe problem freely Yes ______No ______</p><p>8. Doctor ask questions about history, origins of problem? Yes ______No ______</p><p>9. Doctor listens to responses Yes ______No ______</p><p>10. Doctor explains exam, treatment Yes ______No ______</p><p>11. Doctor uses technical language only Yes ______</p><p>ANNEX E - 6 No ______</p><p>12. Clinical encounter ends abruptly Yes ______No ______</p><p>13. Adult appears to want more advice or information Yes ______No ______</p><p>14. Adult appears to expect additional treatment that was not given Yes ______No ______</p><p>15. Adult appears to understand child's disease and treatment after doctor's explanation Yes ______No ______</p><p>OBSERVER NOTES AND COMMENTS:</p><p>ANNEX E - 7 Example 2: Bangladesh Diarrhea Study - Dispensing Process Observation Form</p><p>IDENTIFYING INFORMATION</p><p>Health Facility: ______Dept:______Date:______</p><p>Visit ID: ______Time of Visit:______</p><p>Patient Age (yrs,mos): ______Sex:______Accompanied by: ______</p><p>DISPENSER-PATIENT INTERACTION</p><p>Length of dispensing process (seconds): ______Dispenser: ______</p><p>Type: ______</p><p>COMMUNICATION</p><p>Prescriber</p><p>Patient</p><p>Not</p><p>Initiated</p><p>Initiated</p><p>Discussed Description of the drugs dispensed</p><p>______</p><p>______</p><p>______Instructions on how to take drugs</p><p>ANNEX E - 8 ______</p><p>______</p><p>______Cautions, side effects mentioned</p><p>______</p><p>______</p><p>______Information about prevention/care</p><p>______</p><p>______</p><p>______</p><p>DISPENSING ACTIONS Yes No Does Not Apply Sterile technique followed for injection ______</p><p>______</p><p>______</p><p>Drugs labeled with (Check one or more):</p><p>Patient name:______Drug name: ______How to take:______No label: ______</p><p>Type of package in which drugs dispensed (Check one or more):</p><p>Plastic/glass bottle: ______Plastic bag: ______Envelope: ______Folded paper: ______None: ______</p><p>ANNEX E - 9 DESCRIPTION OF THE DISPENSING ENCOUNTER</p><p>1. Conversation initiated by dispenser Yes ______No ______</p><p>2. Conversation initiated by patient/caretaker</p><p>Yes</p><p>______No</p><p>______</p><p>3. Explanation given by dispenser</p><p>Yes</p><p>______No</p><p>______</p><p>4. Questions raised by patient/caretaker</p><p>Yes</p><p>______No</p><p>______</p><p>5. Dispenser answered patient questions</p><p>Yes</p><p>______No</p><p>ANNEX E - 10 ______</p><p>6. Dispenser explained about drugs </p><p>Yes</p><p>______No</p><p>______</p><p>7. Dispenser used technical language only</p><p>Yes</p><p>______No</p><p>______</p><p>8. Dispenser used local language</p><p>Yes</p><p>______No</p><p>______</p><p>9. Patient/client asked for more drugs Yes ______No ______</p><p>10. Dispenser marked unavailable drugs on prescription</p><p>Yes</p><p>______No</p><p>______</p><p>ANNEX E - 11 11. Dispenser told patient/client to buy unavailable drugs at outside store Yes</p><p>______No</p><p>______</p><p>OBSERVER NOTES AND COMMENTS:</p><p>ANNEX E - 12 Example 3: Nigeria Malaria Study - Clinical Process Observation Form</p><p>IDENTIFYING INFORMATION</p><p>Health Facility: ______Dept:______Date:______</p><p>Visit ID: ______Time of Visit:______</p><p>Patient Age (yrs,mos): ______Sex:______Accompanied by: ______</p><p>PRESCRIBER - PATIENT INTERACTION</p><p>Length of Clinical Consultation (minutes)______Provider Type:______</p><p>DIAGNOSTIC COMMUNICATION Prescriber</p><p>Patient</p><p>Not</p><p>Asked</p><p>Volunteered</p><p>Discussed</p><p>Length of current episode?</p><p>______</p><p>______</p><p>______Patient mentions malaria?</p><p>______</p><p>ANNEX E - 13 ______</p><p>______Previous treatment for this episode? ______</p><p>______</p><p>______Last time treated for malaria?</p><p>______</p><p>______</p><p>______Name of drug used to treat last time? ______</p><p>______</p><p>______Finished last course of treatment?</p><p>______</p><p>______</p><p>______Risk factors (near river, near bush, mosquitoes, etc.)?</p><p>______</p><p>______</p><p>______Communication about presence of: fever?</p><p>______</p><p>ANNEX E - 14 ______</p><p>______headache?</p><p>______</p><p>______</p><p>______malaise?</p><p>______</p><p>______</p><p>______muscle weakness?</p><p>______</p><p>______</p><p>______loss of appetite?</p><p>______</p><p>______</p><p>______chills?</p><p>______</p><p>______</p><p>______vomiting?</p><p>ANNEX E - 15 ______</p><p>______</p><p>______metal taste in mouth?</p><p>______</p><p>______</p><p>______If patient is a child: Child-vomiting?</p><p>______</p><p>______</p><p>______Child still eating/drinking? ______</p><p>______</p><p>______</p><p>EXAMINATION/TREATMENT Examined</p><p>Not</p><p>Does Examined Not Apply Temperature measured?</p><p>______</p><p>______</p><p>______Patient touched for fever?</p><p>ANNEX E - 16 ______</p><p>______</p><p>______Pulse felt?</p><p>______</p><p>______</p><p>______Sclera of eyes examined?</p><p>______</p><p>______</p><p>______Tongue examined?</p><p>______</p><p>______</p><p>______Listens to chest?</p><p>______</p><p>______</p><p>______Palpates abdomen?</p><p>______</p><p>______</p><p>ANNEX E - 17 ______</p><p>ANNEX E - 18 TREATMENT</p><p>Yes</p><p>No</p><p>Does Not Apply Injection given?</p><p>______</p><p>______</p><p>______Sterile technique followed for injection? ______</p><p>______</p><p>______Advised lab test?</p><p>______</p><p>______</p><p>______Advised exam at different facility?</p><p>______</p><p>______</p><p>______Advised return visit if not better?</p><p>______</p><p>______</p><p>ANNEX E - 19 ______</p><p>COMMUNICATION/ADVICE</p><p>Prescriber</p><p>Patient</p><p>Not Initiated Initiated</p><p>Discussed Patient asked for: injection?</p><p>______</p><p>______</p><p>______chloroquine?</p><p>______</p><p>______</p><p>______halfantrine?</p><p>______</p><p>______</p><p>______other specific drug?</p><p>______</p><p>______</p><p>______Provider explained drugs prescribed? ______</p><p>ANNEX E - 20 ______</p><p>______Provider advised about mosquitoes? ______</p><p>______</p><p>______Provider advised about prevention? ______</p><p>______</p><p>______Provider advised about nutrition?</p><p>______</p><p>______</p><p>______</p><p>QUALITY OF PROVIDER-PATIENT INTERACTION</p><p>Yes No Does Not Apply Patient greeted prescriber? ______</p><p>______Prescriber greeted patient? ______</p><p>______Friendly conversation? ______</p><p>______Provider reassured patient? ______</p><p>______</p><p>ANNEX E - 21 Patient encouraged to describe problem freely? ______</p><p>______Doctor listened to responses? ______</p><p>______Encounter ended abruptly? ______</p><p>______Patient appears to want more information? ______</p><p>______</p><p>OBSERVER NOTES AND COMMENTS:</p><p>ANNEX E - 22 Example 4: WHO/CDD Drug Sellers Study - Pharmacy Encounter Observation Form</p><p>Age of person with diarrhoea: (1=< 1 year / 2=1-4 years / 3=5 and over): ______Identity of person visiting shop (1=mother / 2=father / 3=sibling / 4=other): ______Presence of absence of prescription: (1=came with prescription / 2=no prescription) ______Sales attendant type (1=Pharmacist / 2=Assistant Pharmacist / 3=Other): ______</p><p>1. Which of the following issues were discussed during the visit? Sales Attendant Customer Not Mentioned First Mentioned First Discussed Presence of fever / blood in stool ______Presence of vomiting / stomach pains ______Dehydration / loss of fluid ______Food, fluids, or drugs taken by patient ______Description of what specific drugs do ______Use of traditional remedies ______Use of ORS/ORT ______Proper dosage / frequency of drugs ______Cautions / side effects of drugs ______</p><p>2. Which of the following did the shop attendant recommend?</p><p>Visit a doctor if the diarrhoea persists, child vomits, or runs a fever ______Continue to give fluids and foods, or increase fluid to prevent dehydration ______</p><p>If advice was given: What was the customer's reaction to the advice? (1=Accepted without question / 2=Accepted but asked questions / 3=Accepted after persuasion) / 4=Did not accept) ______</p><p>3. Which products were recommended? Write 'NONE' if none were recommended. # of Units # of Units Price Name Recommended Purchased Paid</p><p> a.______</p><p>ANNEX E - 23 b.______</p><p> c.______</p><p> d.______</p><p> e.______</p><p>4. Who seems most responsible for the treatment given: a medical practitioner, the sales attendant, or the customer? Explain why, and describe any factors you feel influenced the behaviour of the sales attendant or customer.</p><p>______</p><p>______</p><p>______</p><p>ANNEX E - 24</p>