Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
Trials. 2012 Jan 6;13:4. doi: 10.1186/1745-6215-13-4.
Governments 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/DESIGN: A 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.
ClinicalTrials.gov: NCT00981877.
非洲各国政府和捐助者都在寻找可持续、负担得起且具有成本效益的方法，以提高疟疾病例管理质量。在公共和私营卫生机构中，为发热患者提供治疗的医疗保健提供者在处方和咨询实践中存在广泛的不足。喀麦隆也不例外，国家指南的遵守率低，经常选择不推荐的抗疟药物，并且剂量不正确。本研究评估了引入两种不同的提供者培训包（与快速诊断测试 (RDT) 一起）的效果和成本效益，旨在为提供者提供有效诊断和治疗发热患者所需的知识和实际技能。总体目标是更好地针对抗疟治疗，并促进最佳使用疟疾治疗指南。
方法/设计：将进行一项 3 臂分层、集群随机试验，以评估引入 RDT 与提供者培训（基础或强化）是否比目前没有 RDT 的实践更具成本效益，以及提供者培训干预措施的成本效益是否存在差异。主要结果是报告发热或疑似疟疾并根据疟疾指南接受治疗的就诊设施的患者比例。这将通过在患者（或照顾者）离开公共和传教士卫生设施时进行调查来衡量。成本效益将根据主要结果和一系列次要结果（包括提供者知识的变化）来呈现。将从社会和提供者的角度使用标准经济评估方法来估算成本。
ClinicalTrials.gov：NCT00981877。
