The PRIME trial: Improving health centres to reduce childhood malaria in Uganda

[Project summary in Français / Português]

Scientific title: 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

What did we know before this research?

In Uganda and elsewhere, poor health services may limit appropriate management of fever cases and delivery of good quality care. Ultimately, this could contribute to the lack of progress on malaria control.

In the formative research that preceded our intervention, we identified barriers and aspirations for quality health care. We used these results, together with evidence from studies elsewhere and the inputs of local stakeholders, to identify the most feasible interventions with the greatest potential for impact on health outcomes. 

What does this study add?

The PRIME study is a cluster-randomised trial which is designed to assess whether a complex intervention delivered at public health centres improves health outcomes of children and appropriateness of malaria treatment, as compared to the current standard of care. Such a large-scale trial, evaluating impacts of health facility level interventions on population level outcomes, is rare and will provide much needed evidence of such strategies.

The intervention includes training in health centre management, fever case management with use of rapid diagnostic tests (RDT) for malaria, patient-centred services, as well as ongoing provision of artemether-lumefantrine (a type of ACT) and rapid diagnostic tests when stocks run low. It aims to improve the quality of care delivered and attract patients to seek care at public health centres.

The impact of the PRIME intervention will be evaluated through community surveys of children under fifteen years and of a cohort of children under five, as well as through patient exit interviews at health centres, monthly surveillance and assessment of the knowledge and skills of health workers.

The results of this trial will be supplemented by the PROCESS study, a mixed-methods evaluation which aims to evaluate the implementation, mechanisms of change, context and consequences of the PRIME intervention.

The research team

Principal Investigator

• Dr. Sarah Staedke, London School of Hygiene & Tropical Medicine

Email: Sarah.staedke@lshtm.ac.uk

• Prof Moses Kamya, Professor, Makerere University, Uganda

Other Investigators:

• Dr Grant Dorsey, Associate Professor, University of California, San Francisco
• Dr Clare Chandler, Lecturer, London School of Hygiene & Tropical Medicine
• Prof Philip Rosenthal, Professor, University of California, San Francisco