Effectiveness and cost-effectiveness of interventions to support the introduction of malaria rapid diagnostic tests in Cameroon
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[Project summary in Français / Português]
Scientific title: A cost-effectiveness analysis of provider interventions to improve health worker practice in providing treatment for uncomplicated malaria in Cameroon
Latest on this research
In Cameroon, we have found that interactive training programmes for health workers reduced malaria over diagnosis by half, helping to prevent the wastage of antimalarials on patients who don't need them.
The study compared the use of RDTs when packaged with either a basic or a comprehensive training programme for clinicians. Our results showed that those undertaking the comprehensive programme were much less likely to overuse antimalarials. Only 31% of patients in this group received a malaria drug that they didn’t need, compared to 52% in the group undertaking the basic programme and 84% in the control group which represented the standard practice.
The more effective training package lasted three days and was designed to change prescribing practices. In addition to the content of the basic package, which only provided conventional training on RDTs, malaria diagnosis and treatment, the comprehensive package had smaller groups and longer discussions about clinical guidelines, real-life scenarios and effective communication with patients. It was also more interactive, using card games, drama and problem solving exercises. These training materials are available through the ACT Consortium along with the study protocol and papers that describe problems in malaria case management in Cameroon identified in formative research for this study.
Scroll down to find all resourcesrelated to this study, including the training manuals used in Cameroon, peer-reviewed publications, a policy brief and press releases.
What did we know before this research?
Rapid diagnostic tests (RDT) are a relatively new innovation and can quickly confirm if someone has malaria. These tests are easy to use and do not require laboratory equipment or specialist skills.
Testing patients before prescribing medication is important, and should ensure patients receive the most appropriate treatment. This is important because unnecessary and inappropriate treatment has costs –incurred by patients, but also governments and donors working to control malaria. The cost-effectiveness of rapid diagnostic tests critically depends on health workers prescribing treatment based on the test result.
Background research on malaria case management in Cameroon found that malaria testing was available but under-used, and many health workers prefer to prescribe an antimalarial even when the malaria test has a negative result.
What does this study add?
We designed a cluster randomised trial to compare the introduction of malaria rapid diagnostic tests (RDT) accompanied by either basic training or enhanced training with routine care (in which microscopy was available to identify the presence of malaria parasites in the blood).
Working with the Ministry of Health, one-day basic and three-day enhanced training courses were designed to support the roll-out of malaria rapid diagnostic tests. These training courses are suitable for implementation on a large-scale.
Both training courses show health workers how to use the rapid diagnostic tests and explain which antimalarials are used to treat confirmed cases of uncomplicated malaria. The enhanced course contains additional activities and uses interactive methods – such as drama, games and problem solving exercises – to encourage health workers to use malaria testing and prescribe treatment based on the test results.
This is the first study of a randomised controlled trial that compares different interventions to support the uptake of rapid diagnostic tests and adherence to their results in Cameroon.
The REACT studies in Cameroon and Nigeria will provide an important basis for comparison across different types of health care providers (both private and public), different health care delivery and financing systems, as well as different treatment seeking practices by ethnic and socioeconomic groups. Perhaps most interesting, these intervention trials will allow comparison between sites where currently microscopy testing is widely available (Cameroon) and where the use of any form of malaria diagnostic testing is extremely limited (Nigeria).
The research team
Principal Investigators
- Dr. Virginia Wiseman, London School of Hygiene & Tropical Medicine (virginia.wiseman@lshtm.ac.uk)
- Dr Wilfred Mbacham, University of Yaoundé, Cameroon
Other Investigators
Mrs Lindsay Mangham-Jefferies, London School of Hygiene & Tropical Medicine
Dr Obinna Onwujekwe, College of Medicine, University of Nigeria
Ms Bonnie Cundill, London School of Hygiene & Tropical Medicine
Dr Clare Chandler, London School of Hygiene & Tropical Medicine
Ms Olivia Achonduh, University of Yaoundé
Akindeh Mbuh Nji, University of Yaoundé
Related Publications
Medicine sellers’ perspectives on their role in providing health care in North-West Cameroon: a qualitative study
R Hughes, CR Chandler, LJ Mangham-Jefferies and W Mbacham | Published
Health Policy and Planning
‘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
Clare I.R. Chandler, Lindsay Manghama, Abanda Ngu Njei, Olivia Achonduh, Wilfred F. Mbacham, Virginia Wiseman | Published
Social Science and Medicine
Effectiveness and 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
Virginia Wiseman, Lindsay J Mangham, Bonnie Cundill, Olivia A Achonduh, Akindeh Mbuh Nji, Abanda Ngu Njei, Clare Chandler and Wilfred F Mbacham | Published
Trials Journal
Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon
Lindsay J. Mangham, Bonnie Cundill, Olivia A. Achonduh, Joel N. Ambebila, Albertine K. Lele, Theresia N. Metoh, Sarah N. Ndive, Ignatius C. Ndong, Rachel L. Nguela, Akindeh M. Nji, Barnabas Orang-Ojong, Joelle Pamen-Ngako, Virginia Wiseman and Wilfred F. | Published
Tropical Medicine and International Health
What determines providers' stated preference for the treatment of uncomplicated malaria?
Lindsay Mangham-Jefferies, Kara Hanson, Wilfred Mbacham, Obinna Onwujekwe, Virginia Wiseman | Published
Social Science & Medicine
Basic or enhanced clinician training to improve adherence to malaria treatment guidelines: a cluster-randomised trial in two areas of Cameroon
Wilfred F Mbacham, Lindsay Mangham-Jefferies, Bonnie Cundill, Olivia A Achonduh, Clare I R Chandler, Joel N Ambebila, Armand Nkwescheu, Dorothy Forsah-Achu, Victor Ndiforchu, Odile Tchekountouo, Mbuh Akindeh-Nji, Pierre Ongolo-Zogo, Dr Virginia Wiseman | Published
The Lancet Global Health
Designing and implementing interventions to change clinicians’ practice in the management of uncomplicated malaria: lessons from Cameroon
Olivia A Achonduh, Wilfred F Mbacham, Lindsay Mangham-Jefferies, Bonnie Cundill, Clare Chandler, Joelle Pamen-Ngako, Albertine K Lele, Ignatius C Ndong, Sarah N Ndive, Joel N Ambebila, Barnabas B Orang-Ojong, Theresia N Metoh, Mbuh Akindeh-Nji, Virgini | Published
Malaria Journal
The practice of 'doing' evaluation: lessons learned from nine complex intervention trials in action
Joanna R, Deborah D, Lindsay M, Evelyn A, Sham L, Hilda M, Katia B, Jayne W, Lasse V, Shunmay Y, Toby L, Eleanor H, Hugh R, David L, David S, Bonnie C, Sarah S, Virginia W, Catherine G, Clare C | Published
Implementation Science
Economic evaluation of a cluster randomized trial of interventions to improve health workers’ practice in diagnosing and treating uncomplicated Malaria in Cameroon
Lindsay Mangham-Jefferies, Virginia Wiseman, Olivia A. Achonduh, Thomas L. Drake, Bonnie Cundill, Obinna Onwujekwe, Wilfred Mbacham | Published
Value in Health
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
Lindsay Mangham-Jefferies, Kara Hanson, Wilfred Mbacham, Obinna Onwujekwe, Virginia Wiseman | Published
Health Policy and Planning
Examining intervention design: lessons from the development of eight related malaria health care intervention studies
Clare I.R. Chandler*, Helen Burchett, Louise Boyle, Olivia Achonduh, Anthony Mbonye, Deborah DiLiberto, Hugh Reyburn, Obinna Onwujekwe, Ane Haaland, Arantxa Roca-Feltrer, Frank Baiden, Wilfred F. Mbacham, Richard Ndyomugyenyi, Florence Nankya, Lindsay Man | Published
Health Systems and Reform
REACT Summary of Qualitative results - Cameroon Sept 2010
Summary prepared by Clare I R Chandler and Joanna L Reynolds; Fieldwork with: Abanda Ngu Njei, Olivia Achonduh, Theresia Njuabe, Albertine, Lele, Joelle Pamen, Rachel Nguela, Joel Ambebila, Ignatius Ndong; Analysis with: James Kizito, Miriam Kayendeke | Published