Abstract
BackgroundCase management is one of the principal strategies for malaria control. This study aimed to estimate the economic costs of uncomplicated malaria case management and explore the influence of health-seeking behaviours on those costs.MethodsA knowledge, attitudes and practices (KAP) survey was applied to 680 households of fifteen communities in Mazan-Loreto in March 2017, then a socio-economic survey was conducted in September 2017 among 161 individuals with confirmed uncomplicated malaria in the past 3 months. Total costs per episode were estimated from both provider (Ministry of Health, MoH) and patient perspectives. Direct costs were estimated using a standard costing estimation procedure, while the indirect costs considered the loss of incomes among patients, substitute labourers and companions due to illness in terms of the monthly minimum wage. Sensitivity analysis evaluated the uncertainty of the average cost per episode.ResultsThe KAP survey showed that most individuals (79.3%) that had malaria went to a health facility for a diagnosis and treatment, 2.7% received those services from community health workers, and 8% went to a drugstore or were self-treated at home. The average total cost per episode in the Mazan district was US$ 161. The cost from the provider’s perspective was US$ 30.85 per episode while from the patient’s perspective the estimated cost was US$ 131 per episode. The average costs per Plasmodium falciparum episode (US$ 180) were higher than those per Plasmodium vivax episode (US$ 156) due to longer time lost from work by patients with P. falciparum infections (22.2 days) than by patients with P. vivax infections (17.0 days). The delayed malaria diagnosis (after 48 h of the onset of symptoms) was associated with the time lost from work due to illness (adjusted mean ratio 1.8; 95% CI 1.3, 2.6). The average cost per malaria episode was most sensitive to the uncertainty around the lost productivity cost due to malaria.ConclusionsDespite the provision of free malaria case management by MoH, there is delay in seeking care and the costs of uncomplicated malaria are mainly borne by the families. These costs are not well perceived by the society and the substantial financial impact of the disease can be frequently undervalued in public policy planning.
Highlights
Case management is one of the principal strategies for malaria control
Attitudes and practices (KAP) Knowledge most of the 680 responders knew that malaria is transmitted by infected mosquitoes; 22% of responders pointed out that malaria was acquired by drinking stagnant water and nobody knew that malaria could be transmitted through blood transfusion
Access to prompt diagnosis and treatment is one of the principal strategies for malaria control and elimination. This includes two components, one dependent upon the patient to seek care when sick and the other being the availability of accessible diagnosis and treatment facilities
Summary
Case management is one of the principal strategies for malaria control. This study aimed to estimate the economic costs of uncomplicated malaria case management and explore the influence of health-seeking behav‐ iours on those costs. The 2030 Sustainable Development Goals (SDGs) “to ensure healthy lives and promote wellbeing for all at all ages” [2] challenge the health sector, not least because Peruvian health expenditure are among the lowest in the Americas (about 5% of Gross Domestic Product-GDP) [3], substantial health inequities persist [4], and communicable diseases such as malaria resurge [5, 6]. The Amazon Region, mainly the department of Loreto, is commonly affected by malaria due to both Plasmodium vivax and Plasmodium falciparum (P. vivax/P. falciparum ratio: 4/1), accounting for more than 95% of Peru’s malaria cases in 2017 (52,280 cases) [9]. A former economic evaluation conducted in 1998 from the perspective of society found that malaria costs were mainly borne by the families [11]
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