A cost-effectiveness analysis of provider and community interventions to improve the treatment of uncomplicated malaria in Nigeria: study protocol for a randomized controlled trial.
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
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.


BACKGROUND
Clinicaltrials.gov NCT01350752.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. virginia.wiseman@lshtm.ac.uk
Virginia
V
Wiseman
Ezeoke
E
Ogochukwu
Nwala
N
Emmanuel
Mangham
M
Lindsay J
Cundill
C
Bonnie
Enemuo
E
Jane
Uchegbu
U
Eloka
Uzochukwu
U
Benjamin
Onwujekwe
O
Obinna
D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003153:Community Health Services / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics*; D016527:Drug Costs; D004359:Drug Therapy, Combination; D019983:Guideline Adherence; D017048:Health Care Costs; D006282:Health Personnel / Q000191:economics* / Q000193:education / Q000523:psychology; D006801:Humans; D007318:Inservice Training / Q000191:economics*; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics*; D009549:Nigeria; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011933:Reagent Kits, Diagnostic / Q000191:economics*; D012107:Research Design; D012572:School Health Services / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome
D000962:Antimalarials; D011933:Reagent Kits, Diagnostic