Social group and health care provider interventions to increase the demand for malaria rapid diagnostic test among community members in Ebonyi state, Nigeria: study protocol for a cluster randomized controlled trial

Abstract

Background: The World Health Organization in 2010 recommended universal testing for suspected malaria cases due to some fundamental changes in malaria trend such as the declining malaria incidence in high burden countries, the emergence of parasite resistance to anti-malarial drugs especially artemisinin-based combination therapies (ACTs) and the increased availability of diagnostic testing such as malaria rapid diagnostic test (MRDT). The Nigerian government has long adopted this recommendation and has scaled up the availability of MRDT with the support of foreign partners. However, the malaria/MRDT test rate in the communities is still far short of the recommendation. This study aims to evaluate the effectiveness of social group and social group/provider interventions in increasing the demand (use and/or request) for MRDT among community members with fever or malaria-like illness in Ebonyi state, Nigeria. Methods: A three-arm, parallel, stratified cluster randomized design will be used to evaluate the effect of two interventions compared to control: control involves the usual practice of provision of MRDT services by public primary health care providers and patent medicine vendors; social group intervention involves the sensitization/education of social groups about MRDT; social group/provider intervention involves social group treatment plus the training of health care providers in health communication with clients about MRDT. The primary outcome is the proportion of under-5 children with fever/malaria-like illness in the preceding two weeks to a household survey that received MRDT. The co-primary outcome is the proportion of 5 years and above children and adults (excluding pregnant women) with fever/malaria-like illness in the preceding two weeks to a household survey that received MRDT. The primary outcome will be assessed through household surveys at baseline and end-line. Discussion: The pragmatic and behavioural nature of the interventions which are delivered to groupings of individuals and the need to minimize contamination informed the use of a cluster randomized design by this study in investigating whether the social group and social group/provider interventions will increase the demand for MRDT among community members. “Pragmatic” means the interventions would occur in natural settings or real live situations.