Abstract
BackgroundMalaria, pneumonia and diarrhoea continue to be the leading causes of death in children under the age of five years (U5) in Uganda. To combat these febrile illnesses, integrated community case management (iCCM) delivery models utilizing community health workers (CHWs) or drug sellers have been implemented. The purpose of this study is to compare the cost-effectiveness of delivering iCCM interventions via drug sellers versus CHWs in rural Uganda.MethodsThis study was a cost-effectiveness analysis to compare the iCCM delivery model utilizing drug sellers against the model using CHWs. The effect measure was the number of appropriately treated U5 children, and data on effectiveness came from a quasi-experimental study in Southwestern Uganda and the inSCALE cross-sectional household survey in eight districts of mid-Western Uganda. The iCCM interventions were costed using the micro-costing (ingredients) approach, with costs expressed in US dollars. Cost and effect data were linked together using a decision tree model and analysed using the Amua modelling software.ResultsThe costs per 100 treated U5 children were US$591.20 and US$298.42 for the iCCM trained-drug seller and iCCM trained-CHW models, respectively, with 30 and 21 appropriately treated children in the iCCM trained-drug seller and iCCM trained-CHW models. When the drug seller arm (intervention) was compared to the CHW arm (control), an incremental effect of 9 per 100 appropriately treated U5 children was observed, as well as an incremental cost of US$292.78 per 100 appropriately treated children, resulting in an incremental cost-effectiveness ratio (ICER) of US$33.86 per appropriately treated U5 patient.ConclusionSince both models were cost-effective compared to the do-nothing option, the iCCM trained-drug seller model could complement the iCCM trained-CHW intervention as a strategy to increase access to quality treatment.
Highlights
Malaria, pneumonia and diarrhoea continue to be the leading causes of death in children under the age of five years (U5) in Uganda
Lubogo et al Malar J (2021) 20:407. Since both models were cost-effective compared to the do-nothing option, the integrated community case management (iCCM) trained-drug seller model could complement the iCCM trained-community health worker (CHW) intervention as a strategy to increase access to quality treatment
This study aims to compare the cost-effectiveness of delivering iCCM intervention through drug sellers against utilizing CHWs in rural areas of Uganda
Summary
Pneumonia and diarrhoea continue to be the leading causes of death in children under the age of five years (U5) in Uganda. To combat these febrile illnesses, integrated community case management (iCCM) delivery models utilizing community health workers (CHWs) or drug sellers have been implemented. Sub-Saharan Africa has the world’s highest under-5 mortality rate: 76 deaths per 1000 live births This equates to 1 child in every 13 dying before reaching the age of 5, which is 20 times higher than the rate of 1 in 264 in the region of Australia and New Zealand. In Uganda, the rate of under-5 child mortality is about 46 deaths per 1,000 live births, or one child in every 22 dying before reaching the age of 5 years [1]. In Uganda, the situation is no different, with malaria, pneumonia and diarrhoea remaining the top three causes of death among children under five years, accounting for about 45–60% of these deaths [3]
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