The PRIME trial protocol: Evaluating the impact of an intervention implemented in public health centres on management of malaria and health outcomes of children using a cluster-randomised design in Tororo, Uganda
Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Infectious Disease Research Collaboration, PO Box 7475, Kampala, Uganda; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 95H, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Department of Medicine, University of California, San Francisco, Box 0811, San Francisco, CA, 94143, United States; Department of Medicine, Makerere University, Kampala, Uganda
Background: In Africa, inadequate health services contribute to the lack of progress on malaria control. Evidence of the impact of interventions to improve health services on population-level malaria indicators is needed. We are conducting a cluster-randomised trial to assess whether a complex intervention delivered at public health centres in Uganda improves health outcomes of children and treatment of malaria, as compared to the current standard of care.Methods/Design: Twenty public health centres (level II and III) in Tororo district will be included; 10 will be randomly assigned to the intervention and 10 to control. Clusters will include households located within 2 km of health centres. The trial statistician will generate the random allocation sequence and assign clusters. Health centres will be stratified by level, and restricted randomisation will be employed to ensure balance on cluster location and size. Allocation will not be blinded. The intervention includes training in health centre management, fever case management with use of rapid diagnostic tests (RDTs) for malaria, and patient-centered services, and provision of artemether-lumefantrine (AL) and RDTs when stocks run low. The impact of the intervention on population-level health indicators will be assessed through community surveys conducted at baseline in randomly selected children from each cluster, and repeated annually for two years. The impact on individuals over time will be assessed in a cohort study of children recruited from households randomly selected per cluster. The impact on health centres will be assessed using patient exit interviews, monthly surveillance, and assessment of health worker knowledge and skills. The primary outcome is the prevalence of anaemia (haemoglobin <11.0 g/dL) in individual children under five measured in the annual community surveys. The primary analysis will be based on the cluster-level results.Discussion: The PRIME trial findings will be supplemented by the PROCESS study, an evaluation of the process, context, and wider impact of the PRIME intervention which will be conducted alongside the main trial, together providing evidence of the health impact of a public sector intervention in Uganda. Trial registration and funding: This trial is registered at Clinicaltrials.gov (NCT01024426) and is supported by the ACT Consortium. © 2013 Staedke et al.; licensee BioMed Central Ltd.
article; child; cluster analysis; controlled clinical trial; controlled study; human; information processing; malaria; methodology; outcome assessment; program evaluation; public health; qualitative research; questionnaire; randomized controlled trial; rural health care; total quality management; Uganda; Child; Cluster Analysis; Focus Groups; Humans; Malaria; Outcome Assessment (Health Care); Program Evaluation; Public Health; Qualitative Research; Quality Improvement; Questionnaires; Rural Health Services; Uganda