By Virginia Wiseman1*, Ogochukwu Ezeoke2, Emmanuel Nwala2, Lindsay J Mangham1, Bonnie Cundill3, Jane Enemuo2, Eloka Uchegbu2, Benjamin Uzochukwu2 And Obinna Onwujekwe2
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 costeffectiveness
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 mThere 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 costeffectiveness
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 methodologies.