Abstract
BackgroundMalaria transmission in The Gambia decreased substantially over the last 20 years thanks to the scale-up of control interventions. However, malaria prevalence is still relatively high in eastern Gambia and represents both a health and a financial burden for households. This study aims to quantify the out-of-pocket costs and productivity losses of seeking malaria treatment at household level.MethodsA household survey was carried out through in-person interviews. Respondents were asked about malaria prevention methods, their treatment-seeking behaviour, and any costs incurred for transport, services, food, and/or overnight stays. A bottom-up costing approach was used to calculate the unit cost of treatment and a tobit regression approach to investigate cost drivers.ResultsThe survey included 864 respondents, mainly subsistence farmers. Most respondents (87%) considered malaria to be a problem affecting their ability to perform their regular duties. Respondents preferred going to a health facility for treatment. The primary reason for not going was related to costs; 70% of respondents incurred costs for seeking health care, with a median of £3.62 (IQR: £1.73 to £6.10). The primary driver of cost was living in one of the villages that are off the main road and/or far from health facilities. 66% reported productivity loss of 5 working days on average during a malaria episode of them or their child.ConclusionsAlthough malaria prevalence is decreasing and treatment is provided free of charge, households seeking treatment are confronted with out-of-pocket expenditures and lost working days; particularly in remote villages.
Highlights
Malaria transmission in The Gambia decreased substantially over the last 20 years thanks to the scaleup of control interventions
This study investigated treatment-seeking behaviour and expenditures incurred by households in Upper River Region (URR), The Gambia, when one of their members contracts malaria
The results show that most respondents considered malaria a problem that affects their quality of life and their economic productivity
Summary
Malaria transmission in The Gambia decreased substantially over the last 20 years thanks to the scaleup of control interventions. Malaria prevalence is still relatively high in eastern Gambia and represents both a health and a financial burden for households. In 2017, the estimated global burden of malaria was 219 million cases and 435,000 deaths [1], 90% of which occurring in sub-Saharan Africa [2]. Malaria diagnosis and treatment in The Gambia, as in many other sub-Saharan African countries, is provided free of charge, but indirect costs can still be incurred. Studies from Ghana, Kenya and Ethiopia show that households incur costs for transport, food, and overnight stays in health facilities [9,10,11]. The aim of this study is to fill this knowledge gap by surveying households in URR about their malaria treatmentseeking behaviour and the (in)direct costs they incur whilst doing so
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