Cost analysis of a school-based comprehensive malaria program in primary schools in Sikasso region, Mali

Roberta Maccario,Moussa Sacko,Annie Nagy,Natalie Roschnik,Simon Brooker,Siân E Clarke,Modibo Bamadio,Souleymane Djanken,Josselin Thuilliez,Saba Rouhani,Seybou Diarra,Tom Drake

doi:10.1186/s12889-017-4490-6

Abstract

BackgroundThe expansion of malaria prevention and control to school-aged children is receiving increasing attention, but there are still limited data on the costs of intervention. This paper analyses the costs of a comprehensive school-based intervention strategy, delivered by teachers, that included participatory malaria educational activities, distribution of long lasting insecticide-treated nets (LLIN), and Intermittent Parasite Clearance in schools (IPCs) in southern Mali.MethodsCosts were collected alongside a randomised controlled trial conducted in 80 primary schools in Sikasso Region in Mali in 2010-2012. Cost data were compiled between November 2011 and March 2012 for the 40 intervention schools (6413 children). A provider perspective was adopted. Using an ingredients approach, costs were classified by cost category and by activity. Total costs and cost per child were estimated for the actual intervention, as well as for a simpler version of the programme more suited for scale-up by the government. Univariate sensitivity analysis was performed.ResultsThe economic cost of the comprehensive intervention was estimated to $10.38 per child (financial cost $8.41) with malaria education, LLIN distribution and IPCs costing $2.13 (20.5%), $5.53 (53.3%) and $2.72 (26.2%) per child respectively. Human resources were found to be the key cost driver, and training costs were the greatest contributor to overall programme costs. Sensitivity analysis showed that an adapted intervention delivering one LLIN instead of two would lower the economic cost to $8.66 per child; and that excluding LLIN distribution in schools altogether, for example in settings where malaria control already includes universal distribution of LLINs at community-level, would reduce costs to $4.89 per child.ConclusionsA comprehensive school-based control strategy may be a feasible and affordable way to address the burden of malaria among schoolchildren in the Sahel.

Highlights

The expansion of malaria prevention and control to school-aged children is receiving increasing attention, but there are still limited data on the costs of intervention
The long lasting insecticide-treated nets (LLIN) intervention accounted for the largest portion of the total costs (58% of financial costs, 53% of economic costs), while the Intermittent Parasite Clearance in schools (IPCs) component accounted for approximately one quarter (27% of financial costs, 26% of economic costs)
Our results suggest that human resources were the major driver of costs, followed by LLIN procurement

Summary

Introduction

The expansion of malaria prevention and control to school-aged children is receiving increasing attention, but there are still limited data on the costs of intervention. There is increased recognition of the value of including of schoolaged children in these efforts, due to the high parasite rates in this population and the increasing body of evidence demonstrating developmental consequences of infection throughout childhood and adolescence [8, 9]. Malaria has been associated with reductions in sustained attention, cognition, and school achievement in various settings, including Mali, where this study is based. A longitudinal survey in an area with high and stable malaria transmission area has shown that Plasmodium falciparum infection affects educational achievement and cognitive performance [4]. Similar results have been observed elsewhere [5,6,7]

Objectives

Methods

Results

Discussion

Conclusion