The Second-Round Evaluation of Financial Incentives on Malaria Prevalence in the Lake Victoria Basin, Kenya: Updated Study Protocol for a Cluster-Randomized Controlled Trial

Background : Despite significant progress in global malaria reduction since 2000, driven primarily by supply-side interventions including improvements in bed nets and medication availability, recent years have seen a stagnation in this decline. In certain regions, cases have even increased (1). This trend is particularly concerning in high-burden areas such as Suba South Sub-county in Homa Bay County, Kenya, where malaria remains a persistent public health challenge. However, demand-side barriers—such as lack of knowledge of the disease and perceived costs of prevention and treatment among residents—have been relatively overlooked in control efforts. To address this gap, we conducted a cluster-randomized controlled trial (cRCT) to investigate the impact of an educational intervention and financial incentives on malaria-related behaviors (2). This second-round cRCT aims to build upon the first-round findings, with modifications to the experimental design and educational content to further explore the potential of demand-side interventions and inform future malaria control strategies. Methods : This second-round cRCT will re-randomize the original 92 clusters to either conditional cash transfer (CCT), lottery incentive scheme (LIS), or control arms. Each intervention arm will includeupdated malaria education and financial incentives linked to negative malaria test results, with reward amounts adjusted to reflect local inflation. We will re-assess malaria prevalence using RDT, microscopy, and PCR at three and six months post-intervention. The primary outcomes are changes in malaria prevalence, LLIN usage, and knowledge/perception of malaria. The analysis will combine data from both the first and second rounds to improve statistical power and provide a more comprehensive assessment of the intervention's impact. Discussion : This study addresses the limitations of the first-round trial by increasing statistical power and refining the educational component. By evaluating the effectiveness of demand-side interventions, we aim to inform policy and program design for malaria control in high-burden settings. The resulting evidence on the role of demand-side factors will complement traditional supply-side approaches, ultimately refining future malaria control policies and programs. This research, thereby, has the potential to contribute to the development of sustainable, community-based strategies for malaria elimination. Trial registration : UMIN000053284, registered on 6th January 2024.