{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T12:23:24Z","timestamp":1765887804859},"reference-count":36,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,8,3]]},"abstract":"<jats:p>Optimizing quality of care for malaria and other febrile illnesses is a complex challenge of major public health importance. To evaluate the impact of an intervention aiming to improve malaria case management on the health of community children, a cluster-randomized trial was conducted from 2010\u20132013 in Tororo, Uganda, where malaria transmission is high. Twenty public health centers were included; 10 were randomized in a 1:1 ratio to intervention or control. Households within 2 km of health centers provided the sampling frame for the evaluation. The PRIME intervention included training in fever case management using malaria rapid diagnostic tests (mRDTs), patient-centered services, and health center management; plus provision of mRDTs and artemether\u2013lumefantrine. Cross-sectional community surveys were conducted at baseline and endline (<jats:italic>N<\/jats:italic> = 8,766), and a cohort of children was followed for approximately 18 months (<jats:italic>N<\/jats:italic> = 992). The primary outcome was prevalence of anemia (hemoglobin &lt; 11.0 g\/dL) in children under 5 years of age in the final community survey. The intervention was delivered successfully; however, no differences in prevalence of anemia or parasitemia were observed between the study arms in the final community survey or the cohort. In the final survey, prevalence of anemia in children under 5 years of age was 62.5% in the intervention versus 63.1% in control (adjusted risk ratio = 1.01; 95% confidence interval = 0.91\u20131.13; <jats:italic>P<\/jats:italic> = 0.82). The PRIME intervention, focusing on training and commodities, did not produce the expected health benefits in community children in Tororo. This challenges common assumptions that improving quality of care and access to malaria diagnostics will yield health gains.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0103","type":"journal-article","created":{"date-parts":[[2016,6,7]],"date-time":"2016-06-07T03:04:20Z","timestamp":1465268660000},"page":"358-367","source":"Crossref","is-referenced-by-count":7,"title":["The Impact of an Intervention to Improve Malaria Care in Public Health Centers on Health Indicators of Children in Tororo, Uganda (PRIME): A Cluster-Randomized Trial"],"prefix":"10.4269","volume":"95","author":[{"given":"Sarah G.","family":"Staedke","sequence":"first","affiliation":[{"name":"1Department of Clinical Research, Department of Medical Statistics, Department of Infectious Disease Epidemiology, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom."},{"name":"2Infectious Diseases Research Collaboration, Kampala, Uganda."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Maiteki-Sebuguzi","sequence":"additional","affiliation":[{"name":"2Infectious Diseases Research Collaboration, Kampala, Uganda."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah D.","family":"DiLiberto","sequence":"additional","affiliation":[{"name":"1Department of Clinical Research, Department of Medical Statistics, Department of Infectious Disease Epidemiology, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily L.","family":"Webb","sequence":"additional","affiliation":[{"name":"1Department of Clinical Research, Department of Medical Statistics, Department of Infectious Disease Epidemiology, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Levi","family":"Mugenyi","sequence":"additional","affiliation":[{"name":"2Infectious Diseases Research Collaboration, Kampala, Uganda."},{"name":"3I-Biostat, Hasselt University, Diepenbeek, Belgium."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edith","family":"Mbabazi","sequence":"additional","affiliation":[{"name":"2Infectious Diseases Research Collaboration, Kampala, Uganda."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Gonahasa","sequence":"additional","affiliation":[{"name":"2Infectious Diseases Research Collaboration, Kampala, Uganda."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon P.","family":"Kigozi","sequence":"additional","affiliation":[{"name":"2Infectious Diseases Research Collaboration, Kampala, Uganda."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara A.","family":"Willey","sequence":"additional","affiliation":[{"name":"1Department of Clinical Research, Department of Medical Statistics, Department of Infectious Disease Epidemiology, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grant","family":"Dorsey","sequence":"additional","affiliation":[{"name":"4Department of Medicine, University of California, San Francisco, California."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moses R.","family":"Kamya","sequence":"additional","affiliation":[{"name":"2Infectious Diseases Research Collaboration, Kampala, Uganda."},{"name":"5Makerere University College of Health Sciences, Kampala, Uganda."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare I. R.","family":"Chandler","sequence":"additional","affiliation":[{"name":"1Department of Clinical Research, Department of Medical Statistics, Department of Infectious Disease Epidemiology, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"year":"2014","series-title":"World Malaria Report 2014","author":"World Health Organization","key":"ref1"},{"key":"ref2","series-title":"Nature","first-page":"207","article-title":"The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015","volume":"526","author":"Bhatt","year":"2015"},{"key":"ref3","series-title":"Lancet","first-page":"1703","article-title":"Malaria control in Africa: progress but still much to do","volume":"383","author":"Greenwood","year":"2014"},{"key":"ref4","series-title":"PLoS One","first-page":"e42857","article-title":"Indoor residual spraying of insecticide and malaria morbidity in a high transmission intensity area of Uganda","volume":"7","author":"Kigozi","year":"2012"},{"key":"ref5","series-title":"Malar J","first-page":"435","article-title":"Increasing incidence of malaria in children despite insecticide-treated bed nets and prompt anti-malarial therapy in Tororo, Uganda","volume":"11","author":"Jagannathan","year":"2012"},{"key":"ref6","series-title":"Am J Trop Med Hyg","first-page":"903","article-title":"Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control","volume":"92","author":"Kamya","year":"2015"},{"issue":"(Suppl 1)","key":"ref7","series-title":"Nature","first-page":"39","article-title":"Reducing the burden of childhood malaria in Africa: the role of improved diagnostics","volume":"444","author":"Rafael","year":"2006"},{"key":"ref8","series-title":"BMJ","first-page":"b2606","article-title":"Access to antimalarial therapy: accurate diagnosis is essential to achieving long term goals","volume":"339","author":"Hopkins","year":"2009"},{"year":"2007","series-title":"Everybody's Business: Strengthening Health Systems to Improve Health Outcomes: WHO's Framework for Action","author":"World Health Organization","key":"ref9"},{"key":"ref10","series-title":"BMC Public Health","first-page":"695","article-title":"Parasite-based malaria diagnosis: are health systems in Uganda equipped enough to implement the policy?","volume":"12","author":"Kyabayinze","year":"2012"},{"key":"ref11","series-title":"Trends Parasitol","first-page":"164","article-title":"Overcoming health systems barriers to successful malaria treatment","volume":"29","author":"Rao","year":"2013"},{"key":"ref12","series-title":"Malar J","first-page":"55","article-title":"Improving access to health care for malaria in Africa: a review of literature on what attracts patients","volume":"11","author":"Kizito","year":"2012"},{"issue":"(Suppl 1)","key":"ref13","series-title":"Health Policy Plan","first-page":"i58","article-title":"Improving facility-based care for sick children in Uganda: training is not enough","volume":"20","author":"Pariyo","year":"2005"},{"year":"2015","series-title":"Improving Quality of Care in Low- and Middle-Income Countries: Workshop Summary","author":"National Academies of Sciences Engineering and Medicine","key":"ref14"},{"year":"2012","series-title":"T3: Test. Treat. Track. Scaling Up Diagnostic Testing, Treatment and Surveillance for Malaria","author":"World Health Organization","key":"ref15"},{"key":"ref16","series-title":"Cochrane Database Syst Rev","first-page":"CD008122","article-title":"Rapid diagnostic tests for diagnosing uncomplicated P. falciparum malaria in endemic countries","volume":"7","author":"Abba","year":"2011"},{"key":"ref17","series-title":"Cochrane Database Syst Rev","first-page":"CD008998","article-title":"Rapid diagnostic tests versus clinical diagnosis for managing people with fever in malaria endemic settings","volume":"4","author":"Odaga","year":"2014"},{"key":"ref18","series-title":"Malar J","first-page":"95","article-title":"How can malaria rapid diagnostic tests achieve their potential? A qualitative study of a trial at health facilities in Ghana","volume":"9","author":"Chandler","year":"2010"},{"key":"ref19","series-title":"Lancet Glob Health","first-page":"e346","article-title":"Basic or enhanced clinician training to improve adherence to malaria treatment guidelines: a cluster-randomised trial in two areas of Cameroon","volume":"2","author":"Mbacham","year":"2014"},{"key":"ref20","series-title":"BMC Med","first-page":"118","article-title":"Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: facility-based cluster randomised trial","volume":"13","author":"Cundill","year":"2015"},{"key":"ref21","series-title":"Hum Resour Health","first-page":"13","article-title":"Aspirations for quality health care in Uganda: how do we get there?","volume":"11","author":"Chandler","year":"2013"},{"key":"ref22","series-title":"Glob Health Action","first-page":"29067","article-title":"Behind the scenes of the PRIME intervention: designing a complex intervention to improve malaria care at public health centres in Uganda","volume":"8","author":"DiLiberto","year":"2015"},{"key":"ref23","series-title":"Implement Sci","first-page":"114","article-title":"The PRIME trial protocol: 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","volume":"8","author":"Staedke","year":"2013"},{"key":"ref24","series-title":"Implement Sci","first-page":"113","article-title":"The PROCESS study: a protocol to evaluate the implementation, mechanisms of effect and context of an intervention to enhance public health centres in Tororo, Uganda","volume":"8","author":"Chandler","year":"2013"},{"key":"ref25","series-title":"Malar J","first-page":"111","article-title":"Estimating the annual entomological inoculation rate for Plasmodium falciparum transmitted by Anopheles gambiae s.l. using three sampling methods in three sites in Uganda","volume":"13","author":"Kilama","year":"2014"},{"key":"ref26","series-title":"Malar J","first-page":"2","article-title":"Plasmodium infection and its risk factors in eastern Uganda","volume":"9","author":"Pullan","year":"2010"},{"key":"ref27","series-title":"Int J Epidemiol","first-page":"319","article-title":"Simple sample size calculations for cluster-randomized trials","volume":"28","author":"Hayes","year":"1999"},{"key":"ref28","series-title":"Lancet","first-page":"1623","article-title":"Home management of malaria with artemether-lumefantrine compared with standard care in urban Ugandan children: a randomised controlled trial","volume":"373","author":"Staedke","year":"2009"},{"year":"2009","series-title":"Cluster Randomised Trials","author":"Hayes","key":"ref29"},{"key":"ref30","series-title":"Evaluation","first-page":"471","article-title":"Strengthening patient-centred communication in rural Ugandan health centres: a theory-driven evaluation within a cluster randomised trial","volume":"20","author":"Nayiga","year":"2014"},{"key":"ref31","series-title":"Soc Sci Med","first-page":"10","article-title":"Challenging logics of complex intervention trials: community perspectives of a health care improvement intervention in rural Uganda","volume":"131","author":"Okwaro","year":"2015"},{"year":"2008","series-title":"Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania","author":"Klemick","key":"ref32"},{"key":"ref33","series-title":"Int J Equity Health","first-page":"39","article-title":"Changes in utilization of health services among poor and rural residents in Uganda: are reforms benefitting the poor?","volume":"8","author":"Pariyo","year":"2009"},{"key":"ref34","series-title":"Med Care","first-page":"127","article-title":"The concept of access: definition and relationship to consumer satisfaction","volume":"19","author":"Penchansky","year":"1981"},{"key":"ref35","series-title":"Am J Trop Med Hyg","first-page":"530","article-title":"Accuracy of two malaria rapid diagnostic tests (RDTS) for initial diagnosis and treatment monitoring in a high transmission setting in Uganda","volume":"92","author":"Mbabazi","year":"2015"},{"key":"ref36","series-title":"Lancet","first-page":"1916","article-title":"Effect of the Affordable Medicines Facility\u2013malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data","volume":"380","author":"Tougher","year":"2012"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/2\/article-p358.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/2\/article-p358.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/2\/article-p358.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T21:59:40Z","timestamp":1723067980000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/2\/article-p358.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,8,3]]},"references-count":36,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.16-0103","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2016,8,3]]}}}