A cost-effectiveness analysis of provider interventions to improve health worker practice in providing treatment for uncomplicated malaria in Cameroon: a study protocol for a randomized controlled trial.
BACKGROUND
Governments and donors all over Africa are searching for sustainable, affordable and cost-effective ways to improve the quality of malaria case management. Widespread deficiencies have been reported in the prescribing and counselling practices of health care providers treating febrile patients in both public and private health facilities. Cameroon is no exception with low levels of adherence to national guidelines, the frequent selection of non-recommended antimalarials and the use of incorrect dosages. This study evaluates the effectiveness and cost-effectiveness of introducing two different provider training packages, alongside rapid diagnostic tests (RDTs), designed to equip providers with the knowledge and practical skills needed to effectively diagnose and treat febrile patients. The overall aim is to target antimalarial treatment better and to facilitate optimal use of malaria treatment guidelines.


METHODS
A 3-arm stratified, cluster randomized trial will be conducted to assess whether introducing RDTs with provider training (basic or enhanced) is more cost-effective than current practice without RDTs, and whether there is a difference in the cost effectiveness of the provider training interventions. 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 public and mission health facilities. Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes, including changes in provider knowledge. Costs will be estimated from a societal and provider perspective using standard economic evaluation methodologies.


BACKGROUND
ClinicalTrials.gov: NCT00981877.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. virginia.wiseman@lshtm.ac.uk
Virginia
V
Wiseman
Lindsay J
LJ
Mangham
Bonnie
B
Cundill
Olivia A
OA
Achonduh
Akindeh Mbuh
AM
Nji
Abanda Ngu
AN
Njei
Clare
C
Chandler
Wilfred F
WF
Mbacham
D000488:Allied Health Personnel / Q000191:economics* / Q000193:education*; D000962:Antimalarials / Q000191:economics* / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002163:Cameroon; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics; D019983:Guideline Adherence; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008288:Malaria / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D018803:Models, Economic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics; D011237:Predictive Value of Tests; D012107:Research Design; D016896:Treatment Outcome
D000962:Antimalarials