202 research outputs found
The Economic Costs of Malaria in Children in three Sub-Saharan Countries: Ghana, Tanzania and Kenya.
Malaria causes significant mortality and morbidity in sub-Saharan Africa (SSA), especially among children less than five years of age (U5 children). Although the economic burden of malaria in this region has been assessed previously, the extent and variation of this burden remains unclear. This study aimed to estimate the economic costs of malaria in U5 children in three countries (Ghana, Tanzania and Kenya). Health system and household costs previously estimated were integrated with costs associated with co-morbidities, complications and productivity losses due to death. Several models were developed to estimate the expected treatment cost per episode per child, across different age groups, by level of severity and with or without controlling for treatment-seeking behaviour. Total annual costs (2009) were calculated by multiplying the treatment cost per episode according to severity by the number of episodes. Annual health system prevention costs were added to this estimate. Household and health system costs per malaria episode ranged from approximately US288 for cerebral malaria with neurological sequelae in Kenya. On average, up to 55% of these costs in Ghana and Tanzania and 70% in Kenya were assumed by the household, and of these costs 46% in Ghana and 85% in Tanzania and Kenya were indirect costs. Expected values of potential future earnings (in thousands) lost due to premature death of children aged 0--1 and 1--4 years were US13.8 in Ghana, US8.1 in Tanzania, and US8.9 in Kenya, respectively. The expected treatment costs per episode per child ranged from a minimum of US22.9 for children aged 0--24 months in Kenya. The total annual costs (in millions) were estimated at US131.9 and US11.99, US20.54, respectively. This study provides important insight into the economic burden of malaria in SSA that may assist policy makers when designing future malaria control interventions
Are public-private partnerships the solution to tackle neglected tropical diseases? A systematic review of the literature
Pharmaceutical companies are reluctant to invest in research and development (R&D) of products for neglected tropical diseases (NTDs) mainly due to the low ability-to-pay of health insurance systems and of potential consumers. The available
preventive and curative interventions for NTDs mostly rely on
old technologies and products that are often not adequate.
Moreover, NTDs mostly affect populations living in remote rural
areas and conflict zones, thereby hampering access to
healthcare. The challenges posed by NTDs have led to the
proliferation of a variety of public-private partnerships (PPPs)
in the last decades. We conducted a systematic review to assess
the functioning and impact of these partnerships on the
development of and access to better technologies for NTDs. Our
systematic review revealed a clear lack of empirical assessment
of PPPs: we could not find any impact evaluation analyses, while
these are crucial to realize the full potential of PPPs and to
progress further towards NTDs elimination
The contribution of risk perception and social norms to reported preventive behaviour against selected vector-borne diseases in Guyana
Preventing vector-borne diseases (VBDs) mainly relies on effective vector control tools and strategies, which in turn depend on population acceptance and adherence. Inspired by the abundant recent literature on SARS-COV-2, we investigate the relationship between risk perception and preventive behaviour for selected VBDs and the extent to which risk perception is determined by social norms. We use cross-sectional data collected from 497 individuals in four regions of Guyana in 2017. We use a conditional mixed process estimator with multilevel coefficients, estimated through a Generalized Linear Model (GLM) framework, applying a simultaneous equation structure. We find robust results on malaria: risk perception was significantly influenced by the risk perception of the reference group across different definitions of the reference group, hinting at the existence of social norms. Risk perception significantly increased the likelihood of passive behaviour by 4.48%. Less clear-cut results were found for dengue. This study applies quantitative social science methods to public health issues in the context of VBDs. Our findings point to the relevance of tailoring communications on health risks for VBDs to groups defined at the intersection of socio-economic and demographic characteristics. Such tailored strategies are expected to align risk perception among reference groups and boost preventive behaviour
The impact of a malaria elimination initiative on school outcomes: Evidence from Southern Mozambique
Despite the significant improvements achieved over the last ten years, primary education attainment in Mozambique is still low. Potential reasons acting from the demand perspective include ill health, among other factors. In Mozambique, ill health is still largely linked to malaria, which is a leading cause of outpatient contacts, hospital admissions and death, particularly among under-five and school-aged children. Despite this, in Mozambique and more generally, in malaria endemic countries, the identification and measurement of how improved malaria indicators may contribute to better school outcomes remains largely unknown. In particular, there is a low understanding of the extent to which better health translates immediately into school indicators, such as absenteeism and grades. In this study, we exploit the first year of a malaria elimination initiative implemented in Magude district (Southern Mozambique) that started in 2015, as a quasi-experiment to estimate the impact of malaria on selected primary school outcomes. While malaria was not eliminated, its incidence drastically dropped. We use as control a neighbouring district (Manhiça) with similar socio-economic and epidemiological characteristics. By employing a difference-in-differences (DiD) approach, we examine whether the positive health shock translated into improved school outcomes. Using information from school registers, we generated a dataset on school attendance and grades for 9,848 primary-school students from 9 schools (4 in the treated district and 5 in the control district). In our main specification, a repeated cross-section analysis, we find that the elimination initiative led to a 28% decrease in school absenteeism and a 2% increase in students' grades. Our results are robust across different specifications, including a panel DiD individual fixed effects estimate on a sub-sample of students. These findings provide evidence on the negative impact of malaria on primary education attainment and suggest remarkable economic benefits consequent to its elimination
Evidence of high bed net usage from a list randomization experiments in rural Gambia.
Label: BACKGROUND NlmCategory: BACKGROUND content:
Recording behaviours that have the potential to impact health
can be doubly challenging if the behaviour takes place in
private spaces that cannot be observed directly, and where
respondents answer what they think the recorder may want to
hear. Sleeping under a long-lasting insecticidal net (LLIN) is
an important intervention for malaria prevention, yet it is
difficult to gauge the extent to which coverage (how many nets
are in the community) differs from usage (how many people
actually sleep under a net). List randomization, a novel method
which partially obscures respondents' answers to sensitive
questions, was employed to estimate LLIN usage in The Gambia. -
Label: METHODS NlmCategory: METHODS content: "802
heads-of-household from 15 villages were recruited into a
randomized controlled trial assessing the effect of a housing
intervention on malaria. These houses were randomly assigned to
a housing intervention versus control, with stratification by
village so as to ensure balance between arms. From these, 125
households (63 intervention, 52 control) were randomly selected
for participation in the list randomization experiment, along
with 68 households from the same villages but which were not
part of the housing improvement study, resulting in a total of
196 households for the list randomization experiment.
Approximately half (n\xE2\x80\x89=\xE2\x80\x8997) of the 196
study participants were randomly assigned to the control group
and received a four-question list about non-sensitive
behaviours; the intervention group
(n\xE2\x80\x89=\xE2\x80\x8999) received the same list, with the
addition of one question on a sensitive behaviour: whether or
not they had used a bed net the previous night. Participants
were read the list of questions and then said how many of the
statements were true. Bed net usage was estimated by calculating
the difference in means between the number of affirmative
responses between the two groups." - Label: RESULTS NlmCategory:
RESULTS content: The mean number of affirmative responses in the
control group was 2.60 of four statements (95% confidence
interval, 95% CI 2.50-2.70), compared with 3.68 (95% CI
3.59-3.78) in the intervention group. Such difference (1.08; 95%
CI 94.9-100%) suggests near universal bed net usage. - Label:
CONCLUSIONS NlmCategory: CONCLUSIONS content: Bed net usage by
household heads in these rural villages was found to be high.
Though not entirely unexpected given other studies' estimates of
high bed net usage in the area, the list randomization method
should be further validated in an area with lower coverage
How much will it cost to eradicate lymphatic filariasis? An analysis of the financial and economic costs of intensified efforts against lymphatic filariasis
Introduction
Lymphatic filariasis (LF), a neglected tropical disease (NTD) preventable through mass drug administration (MDA), is one of six diseases deemed possibly eradicable. Previously we developed one LF elimination scenario, which assumes MDA scale-up to continue in all countries that have previously undertaken MDA. In contrast, our three previously developed eradication scenarios assume all LF endemic countries will undertake MDA at an average (eradication I), fast (eradication II), or instantaneous (eradication III) rate of scale-up. In this analysis we use a micro-costing model to project the financial and economic costs of each of these scenarios in order to provide evidence to decision makers about the investment required to eliminate and eradicate LF.
Methodology/Key findings
Costing was undertaken from a health system perspective, with all results expressed in 2012 US dollars (USD). A discount rate of 3% was applied to calculate the net present value of future costs. Prospective NTD budgets from LF endemic countries were reviewed to preliminarily determine activities and resources necessary to undertake a program to eliminate LF at a country level. In consultation with LF program experts, activities and resources were further reviewed and a refined list of activities and necessary resources, along with their associated quantities and costs, were determined and grouped into the following activities: advocacy and communication, capacity strengthening, coordination and strengthening partnerships, data management, ongoing surveillance, monitoring and supervision, drug delivery, and administration. The costs of mapping and undertaking transmission assessment surveys and the value of donated drugs and volunteer time were also accounted for. Using previously developed scenarios and deterministic estimates of MDA duration, the financial and economic costs of interrupting LF transmission under varying rates of MDA scale-up were then modelled using a micro-costing approach. The elimination scenario, which includes countries that previously undertook MDA, is estimated to cost 929 million USD (95% Credible Interval: 884m-972m). Proceeding to eradication is anticipated to require a higher financial investment, estimated at 1.24 billion USD (1.17bn-1.30bn) in the eradication III scenario (immediate scale-up), with eradication II (intensified scale-up) projected at 1.27 billion USD (1.21bn-1.33bn), and eradication I (slow scale-up) estimated at 1.29 billion USD (1.23bn-1.34bn). The economic costs of the eradication III scenario are estimated at approximately 7.57 billion USD (7.12bn-7.94bn), while the elimination scenario is projected to have an economic cost of 5.21 billion USD (4.91bn-5.45bn). Countries in the AFRO region will require the greatest investment to reach elimination or eradication, but also stand to gain the most in cost savings. Across all scenarios, capacity strengthening and advocacy and communication represent the greatest financial costs, whereas mapping, post-MDA surveillance, and administration comprise the least.
Conclusions/Significance
Though challenging to implement, our results indicate that financial and economic savings are greatest under the eradication III scenario. Thus, if eradication for LF is the objective, accelerated scale-up is projected to be the best investment
Rapid diagnostic tests for dengue would reduce hospitalizations, healthcare costs and antibiotic prescriptions in Spain: A cost-effectiveness analysis
Background: Current gold standard diagnostic techniques for dengue are expensive and time-consuming. Rapid diagnostic tests (RDTs) have been proposed as alternatives, although data about their potential impact in non-endemic areas is scarce. Methods: We performed a cost-effectiveness analysis comparing the costs of dengue RDTs to the current standard of care for the management of febrile returning travelers in Spain. Effectiveness was measured in terms of potential averted hospital admissions and reduction of empirical antibiotics, based on 2015-2020 dengue admissions at Hospital Clinic Barcelona (Spain). Results: Dengue RDTs were associated with 53.6% (95% CI: 33.9-72.5) reduction of hospital admissions and were estimated to save 289.08-389.31€ per traveler tested. Moreover, RDTs would have avoided the use of antibiotics in 46.4% (95% CI: 27.5-66.1) of dengue patients. Discussion: Implementation of dengue RDTs for the management of febrile travelers is a cost-saving strategy that would lead to a reduction of half of dengue admissions and a reduction of inappropriate antibiotics in Spain
Economic evaluations of HBV testing and treatment strategies and applicability to low and middle-income countries
BACKGROUND: Many people living with chronic HBV infection remain
undiagnosed until later stages of disease. Increasing testing
and treatment rates form part of the strategy to respond to the
WHO goal of eliminating viral hepatitis as a public health
threat by 2030. However, achieving these ambitious targets is
dependent on finding effective and cost-effective methods of
scale up strategies. The aim of this study was to undertake a
narrative review of the literature on economic evaluations of
testing and treatment for HBV infection, to help inform the
development of the 2017 WHO Hepatitis Testing Guidelines.
METHODS: We undertook a focussed literature review for economic
evaluations on testing for HBV accompanied by antiviral
treatment. The search was carried out in Pubmed and included
only articles published after 2000 and written in English. We
narratively synthesise the results and discuss the key drivers
of cost-effectiveness and their applicability to low and
middle-income countries (LMICs). RESULTS: Nine published studies
were included in this review, only one of which was performed in
a low or middle-income setting in West Africa. Eight studies
were performed in high-income settings, seven among high risk
groups and one among the general population. The studies were
heterogeneous in many respects including the population and
testing strategy under consideration, model structure and
baselines parameters, willingness to pay thresholds and outcome
measures used. However, most studies found HBV testing and
treatment to be cost-effective, even at low HBsAg prevalence
levels. CONCLUSIONS: Currently economic evaluations of HBV
testing and treatment strategies in LMICs is lacking, therefore
limiting the ability to provide formal recommendations on the
basis of cost-effectiveness alone. Further implementation
research is needed in order to help guide national policy
planning
Determinants of household demand for bed nets in a rural area of southern Mozambique
<p>Abstract</p> <p>Background</p> <p>A key to making insecticide-treated nets (ITNs) a long-term, sustainable solution to the spread of malaria is understanding what drives their purchase and use. Few studies have analysed the determinants of demand for bed nets for malaria prevention at the household level, and in particular, how demand for nets compares with demand for other mosquito prevention methods.</p> <p>Methods</p> <p>This study uses a household survey to assess the determinants of demand for bed nets in an area of endemic malaria transmission in rural, southern Mozambique. The study looks at willingness to pay (WTP) for bed nets, net ownership, usage, and past purchase behaviour, alongside expenditure and frequency of use of alternate methods for malaria prevention.</p> <p>Results</p> <p>While overall net ownership in the sample is low, the evidence fails to suggest that poorer households are less likely to own bed nets, when controlling for covariates, nor does the likelihood of receiving a free net depend on socioeconomic status (SES). Formal schooling and market knowledge seem to indicate higher average willingness to pay, while use of alternate methods for malaria prevention, and receipt of Indoor Residual Spraying (IRS) are found to decrease demand for bed nets.</p> <p>Conclusion</p> <p>For long-term sustainability of ITNs to be realized, results suggest that either full or partial subsidies may be necessary in some contexts to encourage households to obtain and use nets. Given the possible substitution effects of combined malaria control interventions, and the danger of not taking into consideration household preferences for malaria prevention, successful malaria control campaigns should invest a portion of their funds towards educating recipients of IRS and users of other preventive methods on the importance of net use even in the absence of mosquitoes.</p
The economic cost to households of childhood malaria in Papua New Guinea: a focus on intra-country variation
Background We compare direct and indirect household costs associated with malaria treatment for children <3 years in two provinces of Papua New Guinea. In particular, we explore the role of uncertainty around mean household costs and whether assuming a normal distribution for household costs limits the accuracy of any direct cost comparisons. Methods Exit surveys were undertaken at inpatient and outpatient health facilities. In order to handle uncertainty and facilitate comparisons, parametric and non-parametric bootstrap methods were used to estimate direct and indirect costs at the individual data level. The inpatient and outpatient incremental costs from Madang and Maprik health facilities were compared and significant differences between provinces were identified. Results Differences were noted between provinces for both inpatient and outpatient household costs. Total arithmetic mean costs for an outpatient malaria episode were US9.20 in Maprik. Total mean inpatient malaria episode costs were US14.08 in Maprik. As cost distributions were not normal, non-parametric bootstrap techniques were used for cost comparisons. Total household costs per outpatient episode of malaria were lower, although not significantly, in Maprik than in Madang (incremental cost of US11.16; 95% CI 5.47, 25.33). A difference was noted between provinces in the proportion of indirect costs in total household costs for an outpatient visit: 76% in Madang vs 94% in Maprik. The proportion for indirect costs associated with inpatient visits varied less: 63% in Madang vs 68% in Maprik. Conclusions Intra-country differences need to be considered in estimating household costs for both outpatient and inpatient malaria treatment. Our findings suggest that it is important to recognize the impact of both direct and indirect costs on individuals' capacity to afford treatment. Certain indirect costs are difficult to measure accurately, particularly respondents' interpretations of their productive versus non-productive time. Despite this, exploring intra-country cost variation can provide important information to health policy maker
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