Evaluating The effectiveness of Reducing Price Barriers to Pediatric Fever Care on Caregiver Decision-making and Illness Outcomes

Last registered on August 27, 2026

Pre-Trial

General Information

Title

RCT ID

AEARCTR-0019380

Initial registration date

August 20, 2026

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published

August 27, 2026, 11:50 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Name

Maria Dieci

Affiliation

Emory University

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Other Primary Investigator(s)

PI Name

Carlos Paramo

PI Affiliation

Boston University

Contact Investigator

Additional Trial Information

Status

In development

Start date

2026-09-01

End date

2028-01-31

Keywords

Health

Additional Keywords

JEL code(s)

Secondary IDs

Prior work

This trial does not extend or rely on any prior RCTs.

Abstract

Background: Febrile illness is a leading cause of serious illness and death for millions of children across sub-
Saharan Africa, despite the availability of diagnostics and appropriate medications. Unfortunately, many fevers
are not treated appropriately due to financial barriers, incorrect or no diagnosis, and inappropriate use of
medications. Inappropriate treatment has uncertain health and economic costs to individuals as well as at a
population level. Objective: The primary objective of this trial is to determine the effectiveness and cost-
effectiveness of pharmacy-based discounts for appropriately dosed azithromycin compared with incentives for
facilitated referrals to a higher level health care facility in the management of malaria negative fevers in children
under five years in Uganda

External Link(s)

Registration Citation

Citation

Dieci, Maria and Carlos Paramo. 2026. "Evaluating The effectiveness of Reducing Price Barriers to Pediatric Fever Care on Caregiver Decision-making and Illness Outcomes." AEA RCT Registry. August 27. https://doi.org/10.1257/rct.19380-1.0

Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)

Control group: All study sites, including the control, have access to price subsidies for ORS, malaria RDTs, malaria ACTs, and over-the- counter painkillers. All study sites, including the control, will have access to referral information to nearby clinics.

Azithromycin discount group: Pharmacies assigned to this arm, in addition to having access to the subsidies and information described in the control group, will also have access to subsidized azithromycin for malaria negative children under 5.

Facilitated referral group: In addition to what is described for the control group, this arm will have access to subsidies for facilitated referrals to nearby clinics (incentives for patients and providers to complete referrals).

Intervention Start Date

2026-09-01

Intervention End Date

2027-08-31

Primary Outcomes

Primary Outcomes (end points)

Illness duration, defined as days to resolution of febrile illness in target child.

Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)

Antibiotics uptake (AZ and otherwise), completed referrals, illness severity, indicators for appropriate and inappropriate clinical advice and treatment courses, and out of pocket spending.

Secondary Outcomes (explanation)

Experimental Design

A sample of 200 eligible pharmacies in Uganda will be randomized into one of three study arms: (1) a control group, (2) a discounted azithromycin group, which offers subsidized prices for Azithromycin to eligible pediatric febrile cases who seek care in the pharmacy, (3) a facilitated referral group, which provides transport allowances facilitate referral visits for follow up care at nearby clinics to eligible pediatric febrile cases who seek care in the pharmacy

Experimental Design Details

Not available

Randomization Method

Stratified randomization done in office by lead investigators. Random seed will be set to equal the Makerere University IRB protocol number for the trial (202630).

Randomization Unit

Cluster-level randomization at the pharmacy level.

Was the treatment clustered?

Yes

Experiment Characteristics

Sample size: planned number of clusters

200 pharmacies

Sample size: planned number of observations

4800 pediatric febrile cases

Sample size (or number of clusters) by treatment arms

80 pharmacies control, 60 pharmacies discounted azithromycin (30 heavy discount, 30 moderate discount), 60 pharmacies facilitated referral (30 high transport allowance, 30 moderate transport allowance)

Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

Supporting Documents and Materials

IRB

Institutional Review Boards (IRBs)

IRB Name

Makerere University

IRB Approval Date

2026-07-07

IRB Approval Number

SBS-2026-30

Analysis Plan