Scientific title: Evaluating the impact of an intervention implemented in public health centres on management of malaria and health outcomes of children using a cluster-randomised design in Tororo, Uganda
In Uganda and elsewhere, poor health services may limit appropriate management of fever cases and delivery of good quality care. Ultimately, this could contribute to the lack of progress on malaria control.
In the formative research that preceded our intervention, we identified barriers and aspirations for quality health care. We used these results, together with evidence from studies elsewhere and the inputs of local stakeholders, to identify the most feasible interventions with the greatest potential for impact on health outcomes.
What Does this study add?
The PRIME study is a cluster-randomised trial which is designed to assess whether a complex intervention delivered at public health centres improves health outcomes of children and appropriateness of malaria treatment, as compared to the current standard of care. Such a large-scale trial, evaluating impacts of health facility level interventions on population level outcomes, is rare and will provide much needed evidence of such strategies.
The intervention includes training in health centre management, fever case management with use of rapid diagnostic tests (RDT) for malaria, patient-centred services, as well as ongoing provision of artemether-lumefantrine (a type of ACT) and rapid diagnostic tests when stocks run low. It aims to improve the quality of care delivered and attract patients to seek care at public health centres.
The impact of the PRIME intervention will be evaluated through community surveys of children under fifteen years and of a cohort of children under five, as well as through patient exit interviews at health centres, monthly surveillance and assessment of the knowledge and skills of health workers.
The results of this trial will be supplemented by the PROCESS study, a mixed-methods evaluation which aims to evaluate the implementation, mechanisms of change, context and consequences of the PRIME intervention.
Dr. Sarah Staedke, London School of Hygiene & Tropical Medicine
Prof Moses Kamya, Professor, Makerere University, Uganda
Dr Grant Dorsey, Associate Professor, University of California, San Francisco
Dr Clare Chandler, Lecturer, London School of Hygiene & Tropical Medicine
Prof Philip Rosenthal, Professor, University of California, San Francisco
Twenty lower-level government-run health centres and their surrounding clusters were included in the study. Ten clusters were randomly assigned to the intervention and ten to control. To evaluate the impact of the intervention, cross-sectional surveys were conducted at baseline in randomly selected children from each cluster, and repeated annually for two years. A cohort of children was recruited from households randomly selected per cluster, and were followed for 18 months. All participating health centres were also assessed using patient exit interviews, health centre surveillance, and assessment of health worker knowledge and skills. The field work began in December 2010 and completed in July 2013.
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