Abstract
BackgroundWhile recognizing the recent remarkable achievement in the global malaria reduction, the disease remains a challenge to the malaria endemic countries in Africa. Beyond the huge health consequence of malaria, policymakers need to be informed about the economic burden of the disease to the households. However, evidence on the economic burden of malaria in Ethiopia is scanty. The aims of this study were to estimate the economic burden of malaria episode and to identify predictors of cost variability to the rural households.MethodsA prospective costing approach from a household perspective was employed. A total of 190 malaria patients were enrolled to the study from three health centers and nine health posts in Adami Tullu district in south-central Ethiopia, in 2015. Primary data were collected on expenditures due to malaria, forgone working days because of illness, socioeconomic and demographic situation, and households’ assets. Quantile regression was applied to predict factors associated with the cost variation. Socioeconomic related inequality was measured using concentration index and concentration curve.ResultsThe median cost of malaria per episode to the household was USD 5.06 (IQR: 2.98–8.10). The direct cost accounted for 39%, while the indirect counterpart accounted for 61%. The history of malaria in the last six months and the level of the facility visited in the health system predominantly influenced the direct cost. The indirect cost was mainly influenced by the availability of antimalarial drugs in the health facility. The concentration curve and the concentration index for direct cost indicate significant pro-rich inequality. Plasmodium falciparum is significantly more costly for households compared to Plasmodium vivax.ConclusionThe economic burden of malaria to the rural households in Ethiopia was substantial—mainly to the poor—indicating that reducing malaria burden could contribute to the poverty reduction as well.
Highlights
An intensified and increased commitment and financial allocation for malaria prevention and control measures have reduced the burden of malaria mortality rate among under five children by 29% globally within five years, since 2010 [1]
The direct cost accounted for 39%, while the indirect counterpart accounted for 61%
The history of malaria in the last six months and the level of the facility visited in the health system predominantly influenced the direct cost
Summary
An intensified and increased commitment and financial allocation for malaria prevention and control measures have reduced the burden of malaria mortality rate among under five children by 29% globally within five years, since 2010 [1]. Despite being a largely preventable and treatable disease, malaria accounts for about 212 million of cases and 429,000 deaths globally in 2015 alone [1]. Sub-Saharan Africa continues to bear a disproportionate share of the global burden with more than 90% of malaria cases and deaths [2] with Ethiopia as one of the hardest-hit countries. Beyond the huge health consequence, malaria imposes a heavy economic burden on individuals, households and the entire economy [3]. Malaria alone reduces the potential economic growth rate by 1.3% per year in some African countries as a single disease [4]. Beyond the huge health consequence of malaria, policymakers need to be informed about the economic burden of the disease to the households. The aims of this study were to estimate the economic burden of malaria episode and to identify predictors of cost variability to the rural households.
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