BACKGROUND: There is mounting evidence of poor adherence by health service personnel to clinical guidelines for malaria following a symptomatic diagnosis. In response to this, the World Health Organization (WHO) recommends that in all settings clinical suspicion of malaria should be confirmed by parasitological diagnosis using microscopy or Rapid Diagnostic Test (RDT). The Government of Nigeria plans to introduce RDTs in public health facilities over the coming year. In this context, we will evaluate the effectiveness and cost-effectiveness of two interventions designed to support the roll-out of RDTs and improve the rational use of ACTs. It is feared that without supporting interventions, non-adherence will remain a serious impediment to implementing malaria treatment guidelines. METHODS/ DESIGN: A three-arm stratified cluster randomized trial is used to compare the effectiveness and cost-effectiveness of: (1) provider malaria training intervention versus expected standard practice in malaria diagnosis and treatment; (2) provider malaria training intervention plus school-based intervention versus expected standard practice; and (3) the combined provider plus school-based intervention versus provider intervention alone. RDTs will be introduced in all arms of the trial. The primary outcome is the proportion of patients attending facilities that report a fever or suspected malaria and receive treatment according to malaria guidelines. This will be measured by surveying patients (or caregivers) as they exit primary health centers, pharmacies, and patent medicine dealers. Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes, including changes in provider and community knowledge. Costs will be estimated from both a societal and provider perspective using standard economic evaluation methodologies. TRIAL REGISTRATION: Clinicaltrials.gov NCT01350752.
RCT Entities:
BACKGROUND: There is mounting evidence of poor adherence by health service personnel to clinical guidelines for malaria following a symptomatic diagnosis. In response to this, the World Health Organization (WHO) recommends that in all settings clinical suspicion of malaria should be confirmed by parasitological diagnosis using microscopy or Rapid Diagnostic Test (RDT). The Government of Nigeria plans to introduce RDTs in public health facilities over the coming year. In this context, we will evaluate the effectiveness and cost-effectiveness of two interventions designed to support the roll-out of RDTs and improve the rational use of ACTs. It is feared that without supporting interventions, non-adherence will remain a serious impediment to implementing malaria treatment guidelines. METHODS/ DESIGN: A three-arm stratified cluster randomized trial is used to compare the effectiveness and cost-effectiveness of: (1) provider malaria training intervention versus expected standard practice in malaria diagnosis and treatment; (2) provider malaria training intervention plus school-based intervention versus expected standard practice; and (3) the combined provider plus school-based intervention versus provider intervention alone. RDTs will be introduced in all arms of the trial. The primary outcome is the proportion of patients attending facilities that report a fever or suspected malaria and receive treatment according to malaria guidelines. This will be measured by surveying patients (or caregivers) as they exit primary health centers, pharmacies, and patent medicine dealers. Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes, including changes in provider and community knowledge. Costs will be estimated from both a societal and provider perspective using standard economic evaluation methodologies. TRIAL REGISTRATION: Clinicaltrials.gov NCT01350752.
Authors: Samuel Shillcutt; Chantal Morel; Catherine Goodman; Paul Coleman; David Bell; Christopher J M Whitty; A Mills Journal: Bull World Health Organ Date: 2008-02 Impact factor: 9.408
Authors: Estelle Rolland; Francesco Checchi; Loretxu Pinoges; Suna Balkan; Jean-Paul Guthmann; Philippe J Guerin Journal: Trop Med Int Health Date: 2006-04 Impact factor: 2.622
Authors: Benjamin S C Uzochukwu; Eric N Obikeze; Obinna E Onwujekwe; Chima A Onoka; Ulla K Griffiths Journal: Malar J Date: 2009-11-23 Impact factor: 2.979
Authors: Holly Ann Williams; Louise Causer; Emmy Metta; Aggrey Malila; Terrence O'Reilly; Salim Abdulla; S Patrick Kachur; Peter B Bloland Journal: Malar J Date: 2008-11-19 Impact factor: 2.979
Authors: Lindsay Mangham-Jefferies; Kara Hanson; Wilfred Mbacham; Obinna Onwujekwe; Virginia Wiseman Journal: Health Policy Plan Date: 2014-10-21 Impact factor: 3.344
Authors: Alinune N Kabaghe; Benjamin J Visser; Rene Spijker; Kamija S Phiri; Martin P Grobusch; Michèle van Vugt Journal: Malar J Date: 2016-03-15 Impact factor: 2.979
Authors: Helen E D Burchett; Baptiste Leurent; Frank Baiden; Kimberly Baltzell; Anders Björkman; Katia Bruxvoort; Siân Clarke; Deborah DiLiberto; Kristina Elfving; Catherine Goodman; Heidi Hopkins; Sham Lal; Marco Liverani; Pascal Magnussen; Andreas Mårtensson; Wilfred Mbacham; Anthony Mbonye; Obinna Onwujekwe; Denise Roth Allen; Delér Shakely; Sarah Staedke; Lasse S Vestergaard; Christopher J M Whitty; Virginia Wiseman; Clare I R Chandler Journal: BMJ Open Date: 2017-03-08 Impact factor: 2.692
Authors: Ugwu I Omale; Benedict N Azuogu; Chihurumnanya Alo; Ugochukwu C Madubueze; Onyinyechukwu U Oka; Kingsley C Okeke; Ifeyinwa M Okafor; Rowland Utulu; Uduak E Akpan; Chijioke V Iloke; Anthonia O Nnubia; Ifeyinwa I Eze; Ogechukwu C Anene; Chukwuka R Nnabu; Deborah C Ibemesi Journal: Trials Date: 2019-10-10 Impact factor: 2.279
Authors: Robin Altaras; Anthony Nuwa; Bosco Agaba; Elizabeth Streat; James K Tibenderana; Sandrine Martin; Clare E Strachan Journal: PLoS One Date: 2016-08-05 Impact factor: 3.240
Authors: Olugbenga A Mokuolu; Olufemi O Ajumobi; Godwin N Ntadom; Olanrewaju T Adedoyin; Alero A Roberts; Chimere O Agomo; Kate U Edozieh; Henrietta U Okafor; Robinson D Wammanda; Friday A Odey; Ibrahim K Maikore; Olatayo O Abikoye; Adekunle D Alabi; Chiomah Amajoh; Bala M Audu Journal: Malar J Date: 2018-05-16 Impact factor: 2.979