Abstract
BackgroundThe control of malaria in schools is receiving increasing attention, but there remains currently no consensus as to the optimal intervention strategy. This paper analyses the costs of intermittent screening and treatment (IST) of malaria in schools, implemented as part of a cluster-randomized controlled trial on the Kenyan coast.MethodsFinancial and economic costs were estimated using an ingredients approach whereby all resources required in the delivery of IST are quantified and valued. Sensitivity analysis was conducted to investigate how programme variation affects costs and to identify potential cost savings in the future implementation of IST.ResultsThe estimated financial cost of IST per child screened is US$ 6.61 (economic cost US$ 6.24). Key contributors to cost were salary costs (36%) and malaria rapid diagnostic tests (RDT) (22%). Almost half (47%) of the intervention cost comprises redeployment of existing resources including health worker time and use of hospital vehicles. Sensitivity analysis identified changes to intervention delivery that can reduce programme costs by 40%, including use of alternative RDTs and removal of supervised treatment. Cost-effectiveness is also likely to be highly sensitive to the proportion of children found to be RDT-positive.ConclusionIn the current context, school-based IST is a relatively expensive malaria intervention, but reducing the complexity of delivery can result in considerable savings in the cost of intervention.(Costs are reported in US$ 2010).
Highlights
The control of malaria in schools is receiving increasing attention, but there remains currently no consensus as to the optimal intervention strategy
The present analysis examines the costs of intermittent screening and treatment (IST) of school children in two districts in coastal
Description of the IST trial A factorial, cluster randomized trial is currently investigating the impact of school-based malaria control and enhanced literacy instruction on the health and educational achievement of school children in Kenya
Summary
The control of malaria in schools is receiving increasing attention, but there remains currently no consensus as to the optimal intervention strategy. Recent evidence suggests that non-severe malaria can affect the cognition, attention and educational achievement of school children [3,4,5,6,7] Reaching this population is most effectively achieved via the school infrastructure, and with increasing enrolment in schools by African schoolage children [8], schools provide a natural access point for malaria control among this age group. Notwithstanding this potential, the optimal approach to controlling malaria in schools remains unclear [4,9]. The present analysis examines the costs of IST of school children in two districts in coastal
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