A cost-effectiveness analysis of provider interventions to improve health worker practice in providing treatment for uncomplicated malaria in Cameroon: a study protocol for a randomized controlled trial

Abstract

BackgroundGovernments and donors all over Africa are searching for sustainable, affordable and cost-effective ways to improve the quality of malaria case management. Widespread deficiencies have been reported in the prescribing and counselling practices of health care providers treating febrile patients in both public and private health facilities. Cameroon is no exception with low levels of adherence to national guidelines, the frequent selection of non-recommended antimalarials and the use of incorrect dosages. This study evaluates the effectiveness and cost-effectiveness of introducing two different provider training packages, alongside rapid diagnostic tests (RDTs), designed to equip providers with the knowledge and practical skills needed to effectively diagnose and treat febrile patients. The overall aim is to target antimalarial treatment better and to facilitate optimal use of malaria treatment guidelines.Methods/DesignA 3-arm stratified, cluster randomized trial will be conducted to assess whether introducing RDTs with provider training (basic or enhanced) is more cost-effective than current practice without RDTs, and whether there is a difference in the cost effectiveness of the provider training interventions. 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 public and mission health facilities. Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes, including changes in provider knowledge. Costs will be estimated from a societal and provider perspective using standard economic evaluation methodologies.Trial RegistrationClinicalTrials.gov: NCT00981877

Designing and implementing interventions to change clinicians’ practice in the management of uncomplicated malaria: lessons from Cameroon

“…A stratified multistage cluster survey was conducted in the two study sites as reported in the study protocol [17]. The quantitative study, carried out through patient exit surveys and clinician/facility surveys, showed that there was over-diagnosis of malaria in health facilities [6] .…”

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

“…Such clinician-oriented interventions have been successful elsewhere when carried out at a local level through participatory workshops (Fonn et al, 2001). We have designed a supporting intervention for providers based on these principles, which will be compared with standard introduction of RDTs in a cluster randomised controlled trial in 2011-12 (clinicaltrials.gov NCT01350752) (Wiseman et al, 2012). Our results also suggest that the role of probabilistic guidelines in routine case management needs to be debated amongst the wider community of clinicians in the professions of medicine and nursing.…”

Mind the gap: knowledge and practice of providers treating uncomplicated malaria at public and mission health facilities, pharmacies and drug stores in Cameroon and Nigeria

“…This exploratory analysis was undertaken to generate hypotheses and guide the design of interventions to support the roll-out of malaria RDTs with updated clinical guidelines. The effectiveness and cost-effectiveness of the interventions are being evaluated in cluster-randomized trials at selected sites in Cameroon and Nigeria ( Wiseman et al 2012a , b ).…”