Abstract
BackgroundMalaria case management is one of the key strategies to control malaria. Various studies have demonstrated the feasibility of home management of malaria (HMM). However, data on the costs and effectiveness of artemisinin-based combination therapy (ACT) and rapid diagnostic tests via HMM is limited.MethodCost-effectiveness of home management versus health facility-based management of uncomplicated malaria in two rural districts in Zambia was analysed from a providers' perspective. The sample included 16 community health workers (CHWs) and 15 health facilities. The outcome measure was the cost per case appropriately diagnosed and treated. Costs of scaling-up HMM nationwide were estimated based on the CHW utilisation rates observed in the study.ResultsHMM was more cost effective than facility-based management of uncomplicated malaria. The cost per case correctly diagnosed and treated was USD 4.22 for HMM and USD 6.12 for facility level. Utilization and adherence to diagnostic and treatment guidelines was higher in HMM than at a health facility.ConclusionHMM using ACT and RDTs was more efficient at appropriately diagnosing and treating malaria than the health facility level. Scaling up this intervention requires significant investments.
Highlights
Malaria case management is one of the key strategies to control malaria
The introduction of rapid diagnostic tests (RDTs) for malaria has changed the approach to malaria diagnosis
A study was carried to evaluate the cost and effectiveness of managing uncomplicated malaria with artemisinin-based combination therapy (ACT) and RDTs using community health workers (CHWs) in comparison with the health facility model. Study design This was a cost-effectiveness evaluation of the management of uncomplicated malaria using the home management of malaria (HMM) strategy versus health facility-based management following the standard malaria treatment guidelines for Zambia
Summary
Various studies have demonstrated the feasibility of home management of malaria (HMM). Data on the costs and effectiveness of artemisinin-based combination therapy (ACT) and rapid diagnostic tests via HMM is limited. Malaria case management is one of the key strategies to control malaria [1]. The adoption of new effective artemisinin-based combination therapy (ACT) in Africa has began to show positive health impacts in terms of malaria morbidity and mortality reduction [1,2] with some countries contemplating malaria elimination [1]. The introduction of rapid diagnostic tests (RDTs) for malaria has changed the approach to malaria diagnosis. With the adoption of RDTs in routine health services, malaria confirmation is no longer a preserve of areas with laboratory services.
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