Research on the Economics of Artemisinin Combination Therapy (ACTs) for the Treatment of Malaria (REACT)

The objective of the REACT project is to evaluate the effectiveness and cost-effectiveness implications of interventions designed to improve health worker practice in providing treatment for uncomplicated malaria to febrile patients attending health facilities in Cameroon and Nigeria.

NIGERIA

Two interventions will be evaluated: (i) provider intervention including introducing RDTs with detailed instructions, one-off training, job aides and on-the-site supportive supervisory visits and (ii) combined provider intervention [as under (i)]and community-based intervention (using primary and secondary schools as focal points)including school malaria events with drama, peer-health education, distribution of health education materials. Types of facilities include: public primary health facilities, private pharmacies and private Patent Medicine Dealers (PMDs)in Enugu State. The two sites in Enugu State are: Enugu urban (comprising of Enugu East, Enugu South and Enugu North Local government areas (LGA) and Udi LGA. The impact of the interventions will be evaluated using a 3-arm stratified, cluster randomized trial with a cluster defined as a geographical community and the two study sites as the strata. The three arms of the trial are:

• Intervention - Provider intervention
• Intervention - Provider plus school-based malaria activities
• Control - Expected practice (once RDTs have been introduced)

CAMEROON

Two interventions will be evaluated: (i) the introduction of rapid diagnostic tests (RDTs) with basic provider training on malaria diagnosis and treatment; and (ii) the basic provider training [as under (i)] plus enhanced provider training to improve the quality of care that includes aspects of interactive self awareness, communication modules between health workers and also between health workers and patients. Types of facilities include: public district hospitals, public health centres (including integrated health centres), mission hospitals and mission health centres (including integrated health centres)in Yaoundé and Bamenda Health Districts. A stratified, cluster randomized trial will be used in which health facilities are the cluster and the two study sites are the strata. The three arms of the trial are:

• Intervention - RDTs with basic provider training;
• Intervention - RDTs with basic plus enhanced provider training;
• Control - which represents current practice and neither intervention will be implemented.

• Behavioral: RDTs & Provider Training on Malaria Diagnosis and Treatment
  In Cameroon and Nigeria, malaria RDTs will be made available in health facilities and health care providers will receive training and job aids on malaria diagnosis and treatment. The training course covers the following topics: clinical and parasitological diagnosis of malaria, how to use a rapid diagnostic test, algorithm based on malaria test result, recommended treatment for confirmed malaria cases (including dosage and regimen for artemisinin-based combination therapies), advice for treatment of test-negative patients
  Other Names:

  • RDTs supplied: SD Bioline
  • Training course
• Behavioral: Extended provider training (Cameroon only)
  2-day training course which supplements basic provider training on malaria diagnosis and treatment, which focuses on understanding change in malaria treatment guidelines, professionalism, and communication skills
  Other Names:

  • provider training
  • quality of care
• Behavioral: School based malaria education (Nigeria only)
  Schools will be invited to undertake activities to raise awareness about malaria RDTs and treatment among children and community members. The intervention includes training teachers on peer health education, malaria awareness activities and providing support to hold a malaria educational event
  Other Names:

  • school based intervention
  • teachers
  • peer health educators

• No Intervention: Control

  In Cameroon: Existing practice (with microscopy widely available)

  In Nigeria: Expected practice (RDTs will be provided with basic instructions)

• Active Comparator: Provider Intervention

  Cameroon: Introduce malaria RDTs with basic provider training and job aids on malaria diagnosis and treatment

  Nigeria: Introduce malaria RDTs with provider training and job aids on malaria diagnosis and treatment

  Intervention: Behavioral: RDTs & Provider Training on Malaria Diagnosis and Treatment
• Active Comparator: Extended intervention

  Cameroon: Introduce malaria RDTs with basic provider training and job aids on malaria diagnosis and treatment AND enhanced provider training on improving quality of care

  Nigeria: Introduce malaria RDTs with provider training and job aids on malaria diagnosis and treatment AND School-based malaria education intervention (with drama, peer-health education and distribution of health education materials)

  Interventions:

  • Behavioral: RDTs & Provider Training on Malaria Diagnosis and Treatment
  • Behavioral: Extended provider training (Cameroon only)
  • Behavioral: School based malaria education (Nigeria only)

Inclusion Criteria:

• the patient (or their caregiver) reports that the patient is suffering from a fever or has a history of fever in this illness episode
• the patient is present at the health facility

Exclusion Criteria:

• the patient is pregnant
• the patient is <6 months old
• the patient has signs or symptoms of severe malaria

• University of Yaounde
• University of Nigeria, Enugu Campus