Evaluation of Home-Based Management of Fever in Urban Ugandan Children

Study Overview
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Brief Summary
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The purpose of this study is to see if providing effective antimalarial treatment at home for parents/guardians to treat their children for malaria will lead to an improved health outcome compared to conventional healthcare.

Detailed Description
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Population: Representative sample of Ugandan children aged 1 to 5 years from 400 households (approximately 540 children). Clinical Site: The study will be conducted in the Mulago III parish community of Kampala, Uganda. Study Duration: 13 months Study Intervention: *Pilot period: After enrollment, households will participate in a one month pilot period to test the household pictorial diaries. At the end of the pilot period, households will be randomized to participation in the home-based management of fever (HBMF) arm or standard care arm for the remainder of the study (12 months). *HBMF arm: Households randomized to the HBMF group will be provided with pre-packaged coartemether to keep at home. Primary caregivers will be instructed to treat children participating in the study empirically with coartemether at home when the child develops fever. Study personnel will distribute drugs and educate the caregivers about administration of drugs, recognition of danger signs of fever/malaria, and when to seek additional care. *Standard care: Households randomized to the standard care arm will be asked to continue their current behaviour and to manage fever in their children as they would normally. Measurements: Household diaries and monthly visits. Primary caregivers will be asked to keep a diary regarding the health of study participants for the duration of the study (13 months). Information on illnesses, treatments given, visits to health care facilities, and health care expenditures will be collected. Study personnel will visit the households monthly to collect completed diaries. At each visit, questionnaires will be administered to gather additional data on the health of the participants and treatment seeking behaviour. Clinical and laboratory evaluations: Temperature, height, weight, mid-upper arm circumference, spleen size, haemoglobin, and thick blood smear will be assessed at enrollment, and at the beginning and end of the intervention period. Study Objectives: 1. To measure the impact of home-based management of fever with coartemether on malaria-related morbidity compared to the current standard of care in the community. 2. To measure the impact of home-based management of fever with coartemether on economic measures compared to the current standard of care in the community. Primary outcome: Treatment incidence density (treatments per time at risk) for each treatment arm Secondary clinical outcomes: 1) mean days of fever; 2) incidence of febrile episodes; 3) mean haemoglobin at study end; 4) change in mean haemoglobin; 5) prevalence of splenomegaly; 6) prevalence of parasitaemia; 7) incidence of visits to health care facilities, and hospitalizations; 8) mortality rate; 9) anthropometric measurements; 10) proportion of appropriate treatments; 11) proportion of delayed treatments; 12) treatment incidence density of treatments given at >50% and at full dose Economic outcomes: 1) household cost/febrile episode; 2) household costs for treatment of febrile episode/month; 3) provider cost/child for delivery of HBMF; 4) estimated provider facility cost/patient for uncomplicated fever, and for severe disease; 5) total net cost/child/year; 6) net cost/additional child appropriately treated; 7) net cost/day of fever averted

Official Title
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Evaluation of Home-Based Management of Fever in Urban Ugandan Children

Conditions
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Malaria, Anemia

Intervention / Treatment
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* Behavioral: Provision of antimalarial treatment at home


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 1 - 5 years Agreement of parents or guardians to provide informed consent Live in Mulago III Parish Exclusion Criteria: History of any known serious chronic disease requiring frequent medical care (e.g. AIDS, sickle cell disease, malignancy) Intention to move from Kampala during the 13 month follow-up period History of serious side effects to study medications Weight < 10 kg Severe malnutrition defined as a weight-for-height or height-for-age Z-score < - 3

Ages Eligible for Study
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Minimum Age: 1 Year
Maximum Age: 5 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Behavioral: Provision of antimalarial treatment at home|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcome measurement will be treatment incidence density (antimalarial treatments received per time at risk) for each study arm. |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean days of fever per participant |  |  | 
| Incidence of febrile episodes |  |  | 
| Mean haemoglobin at study end |  |  | 
| Change in mean haemoglobin between the start and end of the intervention |  |  | 
| Incidence of visits to health care facilities (drug shops, clinics, pharmacies, hospitals) and hospitalizations per participant |  |  | 
| Mortality rate |  |  | 
| Economic outcomes |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Home-based care, Malaria, Africa