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

Trials

Onwujekwe Obinna¹  Uzochukwu Benjamin¹  Uchegbu Eloka¹  Enemuo Jane¹  Cundill Bonnie²  Mangham Lindsay J³  Nwala Emmanuel¹  Ezeoke Ogochukwu¹  Virginia Wiseman³ 

[1] Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria (Enugu Campus), Enugu, Nigeria;Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine

[2] , London, UK;Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK

关键词: Economics;    Guidelines;    Interventions;    Rapid Diagnostic Tests;    Malaria;    Cost-effectiveness;   

Others  :  1095544
DOI  :  10.1186/1745-6215-13-81

 received in 2011-12-19, accepted in 2012-04-03,  发布年份 2012

【 摘 要 】

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

【 授权许可】

   
2012 Wiseman et al.; licensee BioMed Central Ltd

【 图 表 】

Figure 1.

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