The impact of an intervention to introduce malaria rapid diagnostic tests on fever case management in a high transmission setting in Uganda: A mixed-methods cluster-randomized trial (PRIME).

Chandler, C, Webb, EL, Maiteki-Sebuguzi, C, Nayiga, S, Nabirye, C, Diliberto, D, Ssemmondo, E, Dorsey, G, Kamya, MR and Staedke, SG. 2017. The impact of an intervention to introduce malaria rapid diagnostic tests on fever case management in a high transmission setting in Uganda: A mixed-methods cluster-randomized trial (PRIME). [Online]. Figshare. Available from: https://doi.org/10.1371/journal.pone.0170998.

Chandler, C, Webb, EL, Maiteki-Sebuguzi, C, Nayiga, S, Nabirye, C, Diliberto, D, Ssemmondo, E, Dorsey, G, Kamya, MR and Staedke, SG. The impact of an intervention to introduce malaria rapid diagnostic tests on fever case management in a high transmission setting in Uganda: A mixed-methods cluster-randomized trial (PRIME). [Internet]. Figshare; 2017. Available from: https://doi.org/10.1371/journal.pone.0170998.

Chandler, C, Webb, EL, Maiteki-Sebuguzi, C, Nayiga, S, Nabirye, C, Diliberto, D, Ssemmondo, E, Dorsey, G, Kamya, MR and Staedke, SG (2017). The impact of an intervention to introduce malaria rapid diagnostic tests on fever case management in a high transmission setting in Uganda: A mixed-methods cluster-randomized trial (PRIME). [Data Collection]. Figshare. https://doi.org/10.1371/journal.pone.0170998.

Description

Rapid diagnostic tests for malaria (mRDTs) have been scaled-up widely across Africa. The PRIME study evaluated an intervention aiming to improve fever case management using mRDTs at public health centers in Uganda. A cluster-randomized trial was conducted from 2010-13 in Tororo, a high malaria transmission setting. Twenty public health centers were randomized in a 1:1 ratio to intervention or control. The intervention included training in health center management, fever case management with mRDTs, and patient-centered services; plus provision of mRDTs and artemether-lumefantrine (AL) when stocks ran low. Three rounds of Interviews were conducted with caregivers of children under five years of age as they exited health centers (N = 1400); reference mRDTs were done in children with fever (N = 1336). Health worker perspectives on mRDTs were elicited through semi-structured questionnaires (N = 49) and in-depth interviews (N = 10). The primary outcome was inappropriate treatment of malaria, defined as the proportion of febrile children who were not treated according to guidelines based on the reference mRDT. There was no difference in inappropriate treatment of malaria between the intervention and control arms (24.0% versus 29.7%, adjusted risk ratio 0.81 95\% CI: 0.56, 1.17 p = 0.24). Most children (76.0\%) tested positive by reference mRDT, but many were not prescribed AL (22.5\% intervention versus 25.9\% control, p = 0.53). Inappropriate treatment of children testing negative by reference mRDT with AL was also common (31.3\% invention vs 42.4\% control, p = 0.29). Health workers appreciated mRDTs but felt that integrating testing into practice was challenging given constraints on time and infrastructure. The PRIME intervention did not have the desired impact on inappropriate treatment of malaria for children under five. In this high transmission setting, use of mRDTs did not lead to the reductions in antimalarial prescribing seen elsewhere. Broader investment in health systems, including infrastructure and staffing, will be required to improve fever case management.

Methods

Data capture method	Interview
Date (Date published in a 3rd party system)	13 March 2017
Language(s) of written materials	English

People & Groups

Data Creators	Chandler, C, Webb, EL, Maiteki-Sebuguzi, C, Nayiga, S, Nabirye, C, Diliberto, D, Ssemmondo, E, Dorsey, G, Kamya, MR and Staedke, SG
LSHTM Faculty/Department	Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology Faculty of Epidemiology and Population Health > Dept of Medical Statistics Faculty of Infectious and Tropical Diseases > Dept of Clinical Research Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre	ACT Consortium
Participating Institutions	London School of Hygiene & Tropical Medicine, London, United Kingdom, Infectious Diseases Research Collaboration, Kampala, Uganda, University of California, San Francisco, United States of America, Makerere University College of Health Sciences, Kampala, Uganda

Projects

Funders

Project	Funder	Grant Number	Funder URI
ACT Consortium	Bill & Melinda Gates Foundation	ITGBVG01	UNSPECIFIED

Additional Information

Date Deposited	24 Mar 2017 10:52
Last Modified	27 Apr 2022 18:19
Publisher	Figshare

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Description: Original study protocol for the PRIME cluster-randomized trial. Approved by the overseeing ethics committees. DOI:10.1371/journal.pone.0170998.s001

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Description: Final version of the PRIME cluster-randomized trial study protocol, incorporating all amendments approved by the overseeing ethics committees. DOI:10.1371/journal.pone.0170998.s002

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Description: Original version of the PROCESS study protocol which ran alongside the PRIME cluster-randomized trial. Approved by the overseeing ethics committees. DOI:10.1371/journal.pone.0170998.s003

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Filename: S4_PROCESS_Protocol_v1.3.pdf

Description: Final version of PROCESS study protocol, which ran alongside the PRIME cluster randomized trial. This incorporates all amendments approved by the overseeing ethics committees. DOI:10.1371/journal.pone.0170998.s004

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Filename: S5_FCM_Module_Delivery.docx

Description: Delivery of fever case management (FCM) module in the PRIME study. DOI: doi:10.1371/journal.pone.0170998.s005

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Filename: S7_CONSORT_2010_Checklist.docx

Description: Checklist of information to include when reporting a cluster-randomized trial, indicating where specific items are reported within the paper. DOI:10.1371/journal.pone.0170998.s007

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Filename: S6_Heath_Worker_questionnaire.docx

Description: Self-filled questionnaire completed by health workers 10 months after the initial intervention training. Data was used to represent the confidence health workers had in areas covered by the training and supervision. doi:10.1371/journal.pone.0170998.s006

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The impact of an intervention to introduce malaria rapid diagnostic tests on fever case management in a high transmission setting in Uganda: A mixed-methods cluster-randomized trial (PRIME).

Description

Keywords

Methods

People & Groups

Projects

Additional Information

Downloads

Documentation

S1_Prime_Protocol_v1 Download

S2_Prime_Protocol_v1 Download

S3_PROCESS_Protocol_v Download

S4_PROCESS_Protocol_v1 Download

S5_FCM_Module_Delivery Download

S7_CONSORT_2010_Checklist Download

Study Instrument

S6_Heath_Worker_questionnaire Download

External resources

Figshare digital repository (Data)

ACT Consortium (Project)

Associated papers in Research Online