Abstract
BackgroundIntermittent preventive treatment of malaria in children (IPTc) involves the administration of a course of anti-malarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected. IPTc provides a high level of protection against uncomplicated and severe malaria, with monthly sulphadoxine-pyrimethamine plus amodiaquine (SP&AQ) and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens. A key challenge is the identification of a cost-effective delivery strategy.MethodsA community randomized trial was undertaken in Jasikan district, Ghana to assess IPTc effectiveness and costs using SP&AQ delivered in three different ways. Twelve villages were randomly selected to receive IPTc from village health workers (VHWs) or facility-based nurses working at health centres' outpatient departments (OPD) or EPI outreach clinics. Children aged 3 to 59 months-old received one IPT course (three doses) in May, June, September and October. Effectiveness was measured in terms of children covered and adherent to a course and delivery costs were calculated in financial and economic terms using an ingredient approach from the provider perspective.ResultsThe economic cost per child receiving at least the first dose of all 4 courses was US$4.58 when IPTc was delivered by VHWs, US$4.93 by OPD nurses and US$ 5.65 by EPI nurses. The unit economic cost of receiving all 3 doses of all 4 courses was US$7.56 and US$8.51 when IPTc was delivered by VHWs or facility-based nurses respectively. The main cost driver for the VHW delivery was supervision, reflecting resources used for travelling to more remote communities rather than more intense supervision, and for OPD and EPI delivery, it was the opportunity cost of the time spent by nurses in dispensing IPTc.ConclusionsVHWs achieve higher IPTc coverage and adherence at lower costs than facility-based nurses in Jasikan district, Ghana.Trial RegistrationClinicalTrials.gov NCT00119132.
Highlights
Intermittent preventive treatment of malaria is the administration of a full course of an anti-malarial treatment to a population at risk at specified time points, regardless of whether or not they are known to be infected
To date, there is limited evidence on which to base such a decision, with a single comparative cost analysis conducted during the Gambian study, which showed that IPTc was less costly when dispensed by village health workers (VHWs) than by reproductive and child health trekking (RCH) teams, at US$ 1.63 and US$ 3.47 per child covered respectively [6]
The study presented in this paper provides new information on the costs of delivering IPTc through different routes by drawing on the findings of a community randomised trial conducted in Ghana, during which IPTc was dispensed to children by outpatient departments (OPD) or EPI nurses or by VHWs [5]
Summary
Intermittent preventive treatment of malaria is the administration of a full course of an anti-malarial treatment to a population at risk at specified time points, regardless of whether or not they are known to be infected. Different drug combinations were used in different settings with monthly sulphadoxine-pyrimethamine (SP) plus amodiaquine (AQ) and SP plus piperaquine being the most efficacious regimens. Intermittent preventive treatment of malaria in children (IPTc) involves the administration of a course of antimalarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected. IPTc provides a high level of protection against uncomplicated and severe malaria, with monthly sulphadoxinepyrimethamine plus amodiaquine (SP&AQ) and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens. A key challenge is the identification of a cost-effective delivery strategy
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