The Impact of an Intervention to Improve Malaria Care in Public Health Centers on Health Indicators of Children in Tororo, Uganda (PRIME): A Cluster-Randomized Trial.
Optimizing quality of care for malaria and other febrile illnesses is a complex challenge of major public health importance. To evaluate the impact of an intervention aiming to improve malaria case management on the health of community children, a cluster-randomized trial was conducted from 2010-2013 in Tororo, Uganda, where malaria transmission is high. Twenty public health centers were included; 10 were randomized in a 1:1 ratio to intervention or control. Households within 2 km of health centers provided the sampling frame for the evaluation. The PRIME intervention included training in fever case management using malaria rapid diagnostic tests (mRDTs), patient-centered services, and health center management; plus provision of mRDTs and artemether-lumefantrine. Cross-sectional community surveys were conducted at baseline and endline (N = 8,766), and a cohort of children was followed for approximately 18 months (N = 992). The primary outcome was prevalence of anemia (hemoglobin < 11.0 g/dL) in children under 5 years of age in the final community survey. The intervention was delivered successfully; however, no differences in prevalence of anemia or parasitemia were observed between the study arms in the final community survey or the cohort. In the final survey, prevalence of anemia in children under 5 years of age was 62.5% in the intervention versus 63.1% in control (adjusted risk ratio = 1.01; 95% confidence interval = 0.91-1.13; P = 0.82). The PRIME intervention, focusing on training and commodities, did not produce the expected health benefits in community children in Tororo. This challenges common assumptions that improving quality of care and access to malaria diagnostics will yield health gains.
Department of Clinical Research, Department of Medical Statistics, Department of Infectious Disease Epidemiology, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.|Infectious Diseases Research Collaboration, Kampala, Uganda.
Sarah G
SG
Staedke
Infectious Diseases Research Collaboration, Kampala, Uganda.
Catherine
C
Maiteki-Sebuguzi
Department of Clinical Research, Department of Medical Statistics, Department of Infectious Disease Epidemiology, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Deborah D
DD
DiLiberto
Department of Clinical Research, Department of Medical Statistics, Department of Infectious Disease Epidemiology, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Emily L
EL
Webb
Infectious Diseases Research Collaboration, Kampala, Uganda.|I-Biostat, Hasselt University, Diepenbeek, Belgium.
Levi
L
Mugenyi
Infectious Diseases Research Collaboration, Kampala, Uganda.
Edith
E
Mbabazi
Infectious Diseases Research Collaboration, Kampala, Uganda.
Samuel
S
Gonahasa
Infectious Diseases Research Collaboration, Kampala, Uganda.
Simon P
SP
Kigozi
Department of Clinical Research, Department of Medical Statistics, Department of Infectious Disease Epidemiology, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Barbara A
BA
Willey
Department of Medicine, University of California, San Francisco, California.
Grant
G
Dorsey
Infectious Diseases Research Collaboration, Kampala, Uganda.|Makerere University College of Health Sciences, Kampala, Uganda.
Moses R
MR
Kamya
Department of Clinical Research, Department of Medical Statistics, Department of Infectious Disease Epidemiology, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Clare I R
CIR
Chandler
D000740:Anemia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D018512:Parasitemia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology; D015995:Prevalence; D011787:Quality of Health Care / Q000458:organization & administration*; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology
D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes