Abstract
BackgroundGlobal efforts to address the burden of malaria have stagnated in recent years with malaria cases beginning to rise. Substandard and falsified anti-malarial treatments contribute to this stagnation. Poor quality anti-malarials directly affect health outcomes by increasing malaria morbidity and mortality, as well as threaten the effectiveness of treatment by contributing to artemisinin resistance. Research to assess the scope and impact of poor quality anti-malarials is essential to raise awareness and allocate resources to improve the quality of treatment. A probabilistic agent-based model was developed to provide country-specific estimates of the health and economic impact of poor quality anti-malarials on paediatric malaria. This paper presents the methodology and case study of the Substandard and Falsified Antimalarial Research Impact (SAFARI) model developed and applied to Uganda.ResultsThe total annual economic impact of malaria in Ugandan children under age five was estimated at US$614 million. Among children who sought medical care, the total economic impact was estimated at $403 million, including $57.7 million in direct costs. Substandard and falsified anti-malarials were a significant contributor to this annual burden, accounting for $31 million (8% of care-seeking children) in total economic impact involving $5.2 million in direct costs. Further, 9% of malaria deaths relating to cases seeking treatment were attributable to poor quality anti-malarials. In the event of widespread artemisinin resistance in Uganda, we simulated a 12% yearly increase in costs associated with paediatric malaria cases that sought care, inflicting $48.5 million in additional economic impact annually.ConclusionsImproving the quality of treatment is essential to combat the burden of malaria and prevent the development of drug resistance. The SAFARI model provides country-specific estimates of the health and economic impact of substandard and falsified anti-malarials to inform governments, policy makers, donors and the malaria community about the threat posed by poor quality medicines. The model findings are useful to illustrate the significance of the issue and inform policy and interventions to improve medicinal quality.
Highlights
Global efforts to address the burden of malaria have stagnated in recent years with malaria cases beginning to rise
This study developed the SAFARI (Substandard and Falsified Antimalarial Research Impact) model, an agent-based model simulation, to provide country-specific estimates of the health and economic impact of substandard and falsified (SF) anti-malarials on paediatric malaria
At current incidence rates and population levels, the model estimates that there are around 3.5 million annual cases of malaria in Ugandan children under age five
Summary
Between 2006 and 2015, large-scale vector control campaigns, increased prophylactic treatments for pregnant women, as well as improved medical access, testing, and treatment methods reduced the global burden of malaria by an estimated 33 million cases and 435,000 deaths [2,3,4]. This progress has stagnated and even regressed in recent years with malaria cases beginning to rise [2, 5]. These costs disproportionally affect low-and middle-income countries, instigating and reinforcing poverty rates and stunting national economic development [9,10,11]
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.
