Integrated malaria prevention in rural communities in Uganda: an optimization trial protocol

Background: Integrated malaria prevention, which advocates the use several practices at households to prevent the disease, is being explored. Our preliminary research on the approach has been promising regarding its potential contribution to malaria prevention efforts in Uganda. However, the main effects and interaction of the various components of the proposed intervention are unknown. The aim of the study is therefore to conduct an optimization trial on integrated malaria prevention in rural Uganda using the multiphase optimization strategy (MOST). This trial will aim to develop an intervention that delivers the best outcome of reduction in the occurrence of malaria while considering resource constraints such as money, time, and human resource. Methods: A total of 352 households in malaria endemic Bussi sub-county, Wakiso district will be involved in the study. The households will be randomised to one of the 8 experimental conditions. Each condition will represent a combination of the various components of the intervention. These components will be: 1. provision of long-lasting insecticidal nets (which will be a constant hence given to all households); 2. screening all opening on houses including eaves; 3. health education on windows and doors on houses before 6.00pm; and 4. health education on draining stagnant water around houses. Community health workers will be trained to support implementation of the intervention including carrying out health education among the households. Assessments including of the primary outcome (malaria occurrence among children under 5 years of age) and secondary outcome (presence of mosquitoes in houses) will be done at baseline and every 3 months for 12 months. Mediators and moderators (such as housing quality, time of closing windows and doors, and presence of stagnant water) will also be explored between the intervention components and outcomes. Expected outcomes: The study will identify the optimal components of the intervention and associated resources including cost, as well as mediators and moderators of reduction in malaria occurrence. Evidence from this study will be instrumental in informing future decisions on household interventions to prevent malaria to complement existing strategies in endemic countries such as Uganda.