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

Start date: 1 Jan 2010

[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

Latest on this research

[Français / Português]

Twenty lower-level government-run health centres and their surrounding clusters were included in the study. Ten clusters were randomly assigned to the intervention and ten to control. To evaluate the impact of the intervention, cross-sectional surveys were conducted at baseline in randomly selected children from each cluster, and repeated annually for two years.  A cohort of children was recruited from households randomly selected per cluster, and were followed for 18 months.  All participating health centres were also assessed using patient exit interviews, health centre surveillance, and assessment of health worker knowledge and skills.  The field work began in December 2010 and completed in July 2013.

Download the PRIME policy brief, the PRIME training manuals and the main publication of this study (American Journal of Tropical Medicine and Hygiene): 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.

Learn more about the PROCESS study, which developed from PRIME

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


  • 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

Research Themes

Related Publications

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

Sarah G Staedke, Clare IR Chandler, Deborah DiLiberto, Catherine Maiteki-Sebuguzi, Florence Nankya, Emily Webb, Grant Dorsey and Moses R Kamya  |  Published
Implementation Science

Aspirations for quality health care in Uganda: How do we get there?

Clare I R Chandler, James Kizito, Lilian Taaka, Christine Nabirye, Miriam Kayendeke, Deborah DiLiberto and Sarah G Staedke  |  Published
Human Resources for Health

Improving access to health care for malaria in Africa: a review of literature on what attracts patients

James Kizito, Miriam Kayendeke, Christine Nabirye, Sarah G Staedke, and Clare IR Chandler  |  Published
Malaria Journal

An economic evaluation of home management of Malaria in Uganda: An interactive markov model

Yoel Lubell, Anne J. Mills, Christopher J. M. Whitty, Sarah G. Staedke  |  Published

Differential prevalence of transporter polymorphisms in symptomatic and asymptomatic Falciparum Malaria infections in Uganda

Stephen Tukwasibwe, Levi Mugenyi, George W. Mbogo, Sheila Nankoberanyi, Catherine Maiteki-Sebuguzi, Moses L. Joloba, Samuel L. Nsobya, Sarah G. Staedke and Philip J. Rosenthal  |  Published
Journal of Infectious Diseases

Community case management of malaria: exploring support, capacity and motivation of community medicine distributors in Uganda

Kristin Banek, Joaniter Nankabirwa, Catherine Maiteki-Sebuguzi, Deborah DiLiberto, Lilian Taaka, Clare IR Chandler, Sarah G. Staedke  |  Published
Health Policy and Planning

The practice of 'doing' evaluation: lessons learned from nine complex intervention trials in action

Joanna R, Deborah D, Lindsay M, Evelyn A, Sham L, Hilda M, Katia B, Jayne W, Lasse V, Shunmay Y, Toby L, Eleanor H, Hugh R, David L, David S, Bonnie C, Sarah S, Virginia W, Catherine G, Clare C  |  Published
Implementation Science

Strengthening patient-centred communication in rural Ugandan health centres: A theory-driven evaluation within a cluster randomized trial

Susan Nayiga, Deborah DiLiberto, Lilian Taaka, Christine Nabirye, Ane Haaland, Sarah G. Staedke, Clare I. R. Chandler  |  Published

Challenging logics of complex intervention trials: Community perspectives of a health care improvement intervention in rural Uganda

Ferdinand M. Okwaroa, Clare I.R. Chandler, Eleanor Hutchinson, Christine Nabirye, Lilian Taaka, Miriam Kayendeke, Susan Nayiga, Sarah G. Staedke  |  Published
Social Science & Medicine

Behind the scenes of the PRIME intervention: designing a complex intervention to improve malaria care at public health centres in Uganda

Deborah D. DiLiberto, Sarah G. Staedke, Florence Nankya, Catherine Maiteki-Sebuguzi, Lilian Taaka, Susan Nayiga, Moses R. Kamya, Ane Haaland and Clare I. R. Chandler  |  Published
Global Health Action

Examining intervention design: lessons from the development of eight related malaria health care intervention studies

Clare I.R. Chandler*, Helen Burchett, Louise Boyle, Olivia Achonduh, Anthony Mbonye, Deborah DiLiberto, Hugh Reyburn, Obinna Onwujekwe, Ane Haaland, Arantxa Roca-Feltrer, Frank Baiden, Wilfred F. Mbacham, Richard Ndyomugyenyi, Florence Nankya, Lindsay Man  |  Published
Health Systems and Reform

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

Sarah G. Staedke, Catherine Maiteki-Sebuguzi, Deborah D. DiLiberto, Emily L. Webb1, Levi Mugenyi, Edith Mbabazi, Samuel Gonahasa, Simon P. Kigozi, Barbara A. Willey, Grant Dorsey, Moses R. Kamya and Clare I. R. Chandler  |  Published
The American Journal of Tropical Medicine and Hygiene

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