Effect of Integrated Capacity-Building Interventions on Malaria Case Management by Health Professionals in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
PloS one
Abstract
The Integrated Infectious Diseases Capacity Building Evaluation (IDCAP) designed two interventions:
Integrated Management of Infectious Disease (IMID) training program and On-Site Support (OSS). We evaluated their effects
on 23 facility performance indicators, including malaria case management.
Methodology: IMID, a three-week training with two follow-up booster courses, was for two mid- level practitioners,
primarily clinical officers and registered nurses, from 36 primary care facilities. OSS was two days of training and continuous
quality improvement activities for nine months at 18 facilities, to which all health workers were invited to participate.
Facilities were randomized as clusters 1:1 to parallel OSS ‘‘arm A’’ or control ‘‘arm B’’. Outpatient data on four malaria case
management indicators were collected for 14 months. Analysis compared changes before and during the interventions
within arms (relative risk = RR). The effect of OSS was measured with the difference in changes across arms (ratio of
RR = RRR).
Findings: The proportion of patients with suspected malaria for whom a diagnostic test result for malaria was recorded
decreased in arm B (adjusted RR (aRR) = 0.97; 99%CI: 0.82,1.14) during IMID, but increased 25% in arm A (aRR = 1.25;
99%CI:0.94, 1.65) during IMID and OSS relative to baseline; (aRRR = 1.28; 99%CI:0.93, 1.78). The estimated proportion of
patients that received an appropriate antimalarial among those prescribed any antimalarial increased in arm B (aRR = 1.09;
99%CI: 0.87, 1.36) and arm A (aRR = 1.50; 99%CI: 1.04, 2.17); (aRRR = 1.38; 99%CI: 0.89, 2.13). The proportion of patients with a
negative diagnostic test result for malaria prescribed an antimalarial decreased in arm B (aRR = 0.96; 99%CI: 0.84, 1.10) and
arm A (aRR = 0.67; 99%CI: 0.46, 0.97); (aRRR = 0.70; 99%CI: 0.48, 1.00). The proportion of patients with a positive diagnostic
test result for malaria prescribed an antibiotic did not change significantly in either arm.
Description
Keywords
Capacity-Building, Malaria Case Management, Health Professionals, Cluster Randomized Trial Components
Citation
Mbonye MK, Burnett SM, Burua A, Colebunders R, Crozier I, et al. (2014) Effect of Integrated Capacity-Building Interventions on Malaria Case Management by Health Professionals in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components. PLoS ONE 9(1): e84945. doi:10.1371/journal.pone.0084945