A Trial of Improved Financial Access to Healthcare in Ghana

NCT00146692 | Completed Phase 4

• 1 other identifier: ITCR5095
• Study Type: interventional
• Target: 2,000
• Locations: 1 country
• Sites: 1

Brief Summary

Effective control strategies for malaria depend both on preventing disease and on treating those who become infected to prevent significant morbidity and mortality. There are many barriers to preventing access to prompt and effective treatment, some of which are amenable to intervention, others (such as distance to healthcare) less so. This study will concentrate on modifiable financial barriers to care. With the aim of increasing health service utilization and reducing morbidity and mortality among children under five, some governments are currently implementing policies aimed at reducing financial barriers to health care. There is at the same time an on-going debate concerning the relative importance of cost as a barrier to health care. Though theoretically the aim for reducing these barriers should be achieved, its actual impact has not been directly assessed or demonstrated by means of an intervention trial. This study aims to determine by means of a randomized trial the impact of reducing such barriers on morbidity due to severe malaria among children 6 months to five years and on outpatient utilization. An existing pre-payment scheme in the study area will be utilized to improve financial access for half of 2500 households who have not registered for either year I or II. The impact on severe anaemia, mean haemoglobin and anthropometric measurements will be assessed. Health service utilisation rates will be measured in both groups by active and passive surveillance. Patient perceptions and health-seeking behaviour will be compared. The study will contribute to the current debate on the relative importance of cost of care as a barrier to health care and the potential for the removal of this barrier as a strategy for malaria control, and on methods to optimise this.

Conditions

Malaria

Keywords

Malaria; Cost; Treatment; Diagnosis; Africa; Ghana

Outcome Measures

Primary Outcomes (1)

• Prevalence of severe anaemia among children under five years of age after peak malaria transmission season.

Secondary Outcomes (5)

• • Mean haemoglobin count among the two groups at study end

• • Number of admissions to hospital with malaria among children under five years of age in both groups

• • Average number of visits to per child under five years to primary care facility among both groups

• • Anthropometric measurements of children in the two groups

• • All cause mortality in both groups, all ages

Interventions

Free medical treatment BEHAVIORAL

Eligibility Criteria

• Age: 6 Months - 5 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Child in household aged between 6 months and 5 years
• Informed consent from parents
• Household to which child belongs resident in the Dodowa sub district and intending to remain resident until the end of the next two years

You may not qualify if:

• Parents refuse to participate in the study
• Household due to emigrate from study area within two years
• Household currently enrolled

Sponsors & Collaborators

• London School of Hygiene and Tropical Medicine: lead
• Dangme West Health District, Ghana: collaborator

Study Sites (1)

Dangme West District

Dodowa, Ghana

Location

Related Publications (1)

• Ansah EK, Narh-Bana S, Asiamah S, Dzordzordzi V, Biantey K, Dickson K, Gyapong JO, Koram KA, Greenwood BM, Mills A, Whitty CJ. Effect of removing direct payment for health care on utilisation and health outcomes in Ghanaian children: a randomised controlled trial. PLoS Med. 2009 Jan 6;6(1):e1000007. doi: 10.1371/journal.pmed.1000007.

  PMID: 19127975 RESULT

MeSH Terms

Conditions

Malaria; Disease

Condition Hierarchy (Ancestors)

Protozoan Infections; Parasitic Diseases; Infections; Mosquito-Borne Diseases; Vector Borne Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Evelyn Ansah, MD

  Dangme West / LSHTM

  STUDY DIRECTOR

• Christopher Whitty, FRCP

  London School of Hygiene and Tropical Medicine

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: September 5, 2005
• First Posted: September 7, 2005
• Study Start: April 1, 2004
• Study Completion: February 1, 2005
• Last Updated: January 12, 2017

Record last verified: 2017-01

Locations

GH (1)