PROJECT SUMMARY

PROJECT DESCRIPTION

Background

Neglected tropical diseases (NTDs) and malaria remain major public health challenges in Ethiopia and other resource-limited tropical and subtropical countries. Although the World Health Organization (WHO) recommends integrated and cost-effective interventions to achieve the 2030 disease elimination targets, evidence regarding the most effective implementation approaches remains limited. Furthermore, the success of integrated interventions is strongly influenced by context-specific social, cultural, and health system factors that require careful assessment and adaptation. This study aims to evaluate the effectiveness of a context-tailored strategy for integrating malaria and NTD interventions to improve intervention coverage and accelerate progress toward malaria and NTD elimination in line with the Sustainable Development Goals (SDGs).

Methods

This study will be conducted in malaria–NTD co-endemic districts of the South Ethiopia Region from January 2026 to December 2027 using a mixed-methods implementation research approach. At baseline, a descriptive qualitative study will be undertaken to explore context-related factors affecting access to and uptake of malaria and NTD interventions. Findings from the baseline assessment will inform the development of the integrated intervention implementation protocol.

The implementation process will be evaluated using structured checklists, in-depth interviews, key informant interviews, and focus group discussions (FGDs). The qualitative component will include 40–60 in-depth interviews, 10–15 key informant interviews, and 6–10 FGDs to explore contextual factors influencing implementation, acceptability, feasibility, and delivery of integrated malaria and NTD interventions. Qualitative data will be analyzed thematically using NVivo version 15.

The effectiveness of the integrated intervention will be evaluated using an open-label, parallel, two-arm cluster randomized controlled trial. A total of 16 kebeles from the intervention arm and 16 kebeles from the control arm will be enrolled. From each selected kebele, 30 households and all eligible individuals within the selected households will be included in the study.

The primary endpoints will be utilization of long-lasting insecticidal nets (LLINs) and treatment coverage of preventive chemotherapy-targeted NTD interventions. Secondary endpoints will include acceptability, feasibility, equitable access, and cost-effectiveness of the intervention. Quantitative data will be collected using structured questionnaires and direct observations and analyzed using R statistical software. An intention-to-treat (ITT) approach will be applied for both primary and secondary endpoints. Mixed-effects logistic regression models will be employed to account for clustering effects, with intervention effects presented as odds ratios, 95% confidence intervals, and p-values. Secondary analyses will assess interaction effects between types of NTDs integrated with malaria interventions and the modifying influence of gender, socioeconomic status, and other social determinants.

Expected Outcomes

The study is expected to generate evidence on effective approaches for integrating malaria and NTD interventions within routine health systems in Ethiopia. Findings will support national malaria and NTD programs in improving intervention coverage, optimizing resource utilization, reducing implementation costs, and accelerating progress toward disease elimination targets.

Keywords: Malaria; Neglected Tropical Diseases; Integrated interventions; Implementation research; Cluster randomized controlled trial; Cost-effectiveness; South Ethiopia