2.3. The PRIME trial evaluation
The PRIME intervention was evaluated with a cluster randomized trial, comparing 10 health centres randomly assigned to receive the intervention with 10 randomly assigned to ‘standard care’. The main outcomes of interest were anaemia and malaria parasitaemia among clusters of community children living in households within 2 km of each health centre, and malaria case management of patients attending health centres. A full description of the trial protocol has been published elsewhere, including the sample size calculations (Staedke et al., 2013). In brief, the main trial outcomes were evaluated through three sets of activities: three annual surveys with children recruited from a random cross-section of around 30% households in each cluster; a cohort study with around 1000 children across the intervention and standard care clusters, followed up for 18 months through the trial with frequent home and clinic visits compensated with tokens of sugar, soap, tea leaves and salt; and three rounds of exit interviews with a total of 1400 caregivers of children attending all 20 health centres. These evaluation activities are notable because they involved large numbers of community members at the household level, making them more visible than the interventions at the health centers.
3. Methodology
The findings presented in this paper derive from a triangulation of data collected over a year from the start of the intervention in June 2011, including focus group discussions conducted with household heads and caregivers of children, in-depth interviews with key stakeholders, informal discussions with health workers and community members and contextual data collected by the study team. These different methods are described in detail below and formed part of a wider set of evaluation activities described elsewhere (Chandler et al., 2013a).
A total of thirteen focus group discussions were conducted with primary caregivers and heads of households from both the PRIME intervention and standard care arms. The FGDs collected information on community members' perceptions' of health centres' services in different areas of the district, changes, if any, in the quality of care, unexpected impacts of the PRIME, and aimed to understand this in the context of the everyday lives of respondents. Ten of these FGDs were held with primary caregivers (PCGs) and three with household heads. These FGDs were further divided into subgroups by geographical location, in catchment areas of health centres in the PRIME intervention areas, in areas close to health centres allocated to the standard care arm, and in areas outside a radius of 2 km of any health centres.
Ten in-depth interviews were conducted with key stakeholders within the district to collect information on the contextual factors and perceptions of the PRIME intervention as it was being implemented as well as the expected and unexpected impacts of the intervention. Those interviewed included district health officials as well as local political officials from the Tororo sub-district and sub-county levels.
A semi-structured contextual record questionnaire was carried out quarterly over one year to compile information about activities and events that may have affected implementation and impact of the PRIME intervention. A total of 162 records were collected with a cohort of key informants at the district level, each health centre and community level where two informants were selected from each of the seven sub-counties – one health assistant and one lay community member identified as being knowledgeable about local health activities. Informal discussions were held with community members and health workers in the course of the intervention and were later collated, typed, analysed and used to clarify or support information from the other sources.