Cost analysis of a school-based comprehensive malaria program in primary schools in Sikasso region, Mali

Abstract

BackgroundThe expansion of malaria prevention and control to school-aged children is receiving increasing attention, but there are still limited data on the costs of intervention. This paper analyses the costs of a comprehensive school-based intervention strategy, delivered by teachers, that included participatory malaria educational activities, distribution of long lasting insecticide-treated nets (LLIN), and Intermittent Parasite Clearance in schools (IPCs) in southern Mali.MethodsCosts were collected alongside a randomised controlled trial conducted in 80 primary schools in Sikasso Region in Mali in 2010-2012. Cost data were compiled between November 2011 and March 2012 for the 40 intervention schools (6413 children). A provider perspective was adopted. Using an ingredients approach, costs were classified by cost category and by activity. Total costs and cost per child were estimated for the actual intervention, as well as for a simpler version of the programme more suited for scale-up by the government. Univariate sensitivity analysis was performed.ResultsThe economic cost of the comprehensive intervention was estimated to $10.38 per child (financial cost $8.41) with malaria education, LLIN distribution and IPCs costing $2.13 (20.5%), $5.53 (53.3%) and $2.72 (26.2%) per child respectively. Human resources were found to be the key cost driver, and training costs were the greatest contributor to overall programme costs. Sensitivity analysis showed that an adapted intervention delivering one LLIN instead of two would lower the economic cost to $8.66 per child; and that excluding LLIN distribution in schools altogether, for example in settings where malaria control already includes universal distribution of LLINs at community-level, would reduce costs to $4.89 per child.ConclusionsA comprehensive school-based control strategy may be a feasible and affordable way to address the burden of malaria among schoolchildren in the Sahel.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4490-6) contains supplementary material, which is available to authorized users.

An observational analysis of the impact of indoor residual spraying with non-pyrethroid insecticides on the incidence of malaria in Ségou Region, Mali: 2012–2015

“…Even when interpreted with appropriate caution, the observational analyses presented here indicate that the annual IRS campaigns from 2012 to 2015 in the Ségou Region of Mali were good public health investments. Around half a million people were protected for 3 years at a rough cost of around 7.00 USD or less per person per year regardless of which product was sprayed—similar to recent estimates of the cost of distributing LLINs to school children (around 5.50 USD per child [ 60 ]) or delivering community-based SMC (around 4.20 USD per child [ 54 ]) in Mali. These same IRS campaigns were also broadly associated in time and space with rapid decreases in malaria incidence and overall An.…”

School-based social and behavior change communication (SBCC) advances community exposure to malaria messages, acceptance, and preventive practices in Ethiopia: A pre-posttest study

“…Perhaps, this study was the first of its kind to produce findings of exposure based on the needed indicators. However, few school-based studies have focused on changes in students' malaria knowledge and parasitemia [61,62]. In this study, a significant rise (ES = 14.5%) in overall knowledge about malaria and reduction in misconceptions were observed between the two ends.…”

“…Schools and school-based education are currently getting global attention for involvement in public health. For example, school-aged children focused on educational and parasitic clearance intervention studies in Mali suggested a comprehensive school-based control strategy as a feasible and affordable way to address the burden of malaria among school children [61,62]. However, there are limited studies focused on demonstrating that teaching students in school increase awareness at home that the current study aimed for.…”

Impact of a malaria intervention package in schools onPlasmodiuminfection, anaemia and cognitive function in schoolchildren in Mali: a pragmatic cluster-randomised trial

“…The malaria prevention education component of the intervention was estimated to cost $2.13 per child, and the intermittent parasite clearance to cost an additional $2.72 per child treated. 30 In this trial, a combination of SP/AS was used; however, the use of sulphadoxine-pyrimethamine in combination with amodiaquine as recommended by WHO for seasonal malaria chemoprevention in children under 5 years living in areas of highly seasonal transmission in the Sahel subregion 31 would be preferable and would considerably reduce the cost of treatment. A drug combination with a longer half-life, such as dihydroartemisisin-piperaquine, can provide a longer period of protection against new infections 19 but may be more costly and does not necessarily offer the same advantage in all epidemiological situations.…”