Abstract
In Sub-Saharan Africa, malaria remains a major cause of morbidity and mortality among children under 5, due to lack of access to prompt and appropriate diagnosis and treatment. Many countries have scaled-up community health workers (CHWs) as a strategy towards improving access. The present study was a cost-effectiveness analysis of the introduction of malaria rapid diagnostic tests (mRDTs) performed by CHWs in two areas of moderate-to-high and low malaria transmission in rural Uganda. CHWs were trained to perform mRDTs and treat children with artemisinin-based combination therapy (ACT) in the intervention arm while CHWs offered treatment based on presumptive diagnosis in the control arm. Data on the proportion of children with fever ‘appropriately treated for malaria with ACT’ were captured from a randomised trial. Health sector costs included: training of CHWs, community sensitisation, supervision, allowances for CHWs and provision of mRDTs and ACTs. The opportunity costs of time utilised by CHWs were estimated based on self-reporting. Household costs of subsequent treatment-seeking at public health centres and private health providers were captured in a sample of households. mRDTs performed by CHWs was associated with large improvements in appropriate treatment of malaria in both transmission settings. This resulted in low incremental costs for the health sector at US$3.0 per appropriately treated child in the moderate-to-high transmission area. Higher incremental costs at US$13.3 were found in the low transmission area due to lower utilisation of CHW services and higher programme costs. Incremental costs from a societal perspective were marginally higher. The use of mRDTs by CHWs improved the targeting of ACTs to children with malaria and was likely to be considered a cost-effective intervention compared to a presumptive diagnosis in the moderate-to-high transmission area. In contrast to this, in the low transmission area with low attendance, RDT use by CHWs was not a low cost intervention.
Highlights
Malaria remains a major cause of morbidity and mortality among children in sub-Saharan Africa, despite the presence of effective and low cost interventions including artemisinin-based combination therapy (ACT) and insecticide-treated bednets (Jones et al 2003; Black et al 2010; Liu et al 2012; WHO 2015)
In the moderate-to-high transmission area, all pairs of incremental health sector costs and effects were situated in the north-eastern quadrant of the cost-effectiveness plane meaning that the change in number of appropriately treated children was always positive and incremental health sector cost always positive if malaria rapid diagnostic tests (mRDTs) were used (Figure 2a)
Availability of mRDTs among community health workers (CHWs) resulted in a substantial improvement in appropriate treatment of children compared to a situation with presumptive diagnosis in both transmission settings
Summary
Malaria remains a major cause of morbidity and mortality among children in sub-Saharan Africa, despite the presence of effective and low cost interventions including artemisinin-based combination therapy (ACT) and insecticide-treated bednets (Jones et al 2003; Black et al 2010; Liu et al 2012; WHO 2015). A thriving private sector partially fills this gap and common practice in Africa is to treat episodes of fever with over-the-counter medication purchased at drug retail outlets. This may increase the risk of substandard treatment practices; e.g. sale of cheaper ineffective antimalarials rather than ACT, sale of partial doses, or sale of antimalarial drugs without parasitological confirmation (Whitty et al 2008; Kamal-Yanni et al 2012)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
