Economic impact of febrile morbidity and use of permethrin-impregnated bed nets in a malarious area II. Determinants of febrile episodes and the cost of their treatment and malaria prevention.

Abstract

Abstract. The objective of this study is to determine the effect of permethrin insecticide-treated bed net (PITN) use on the incidence of febrile episodes and on household malaria expenses in Benin. Over the course of one year, 208 randomly selected PITN user and non-user households were visited weekly to determine expenditures on febrile morbidity and its treatment, and to monitor spending on malaria prevention. Multivariate analyses were performed to distinguish the effects of PITN use from other important determinants of morbidity, such as malaria-related beliefs and practices, income, and other socio-economic variables. Results from the logistic regression analysis show that the use of PITNs decreases the risk of febrile episodes by 34% in children living in the rural zone. Multiple regression analysis reveals that PITN use does not reduce prevention and treatment expenses. These expenses are significantly associated with women's income. This report also discusses other factors associated with febrile morbidity and malaria-related expenditures.The results of a study performed to promote the use of permethrin insecticide-treated bed nets (PITNs) in a hyperendemic malaria region of Benin show that children living in rural areas have approximately two febrile episodes per year. Caregivers spend an average of US$1.62 for each febrile episode and a total of US$2.52 for treatment of the illness. 1 Chemoprophylaxis expenditures are substantial and are equivalent to roughly half of what it has been observed that the rural populations spends for treatment. However, even though medication is purchased, irregular use of chemoprophylaxis limits its effect.The literature suggests certain hypotheses to explain the factors that affect the number of febrile episodes and malaria prevention spending. For example, it is well known that the frequency of febrile episodes caused by malaria decreases as an individual grows older. In effect, the repeated infections over time aid the natural immunity of an individual to confer some resistance to malaria parasites. 2 This was expected in the present study, since data from the malariometric survey in the study area in 1993 showed significantly lower splenic indices in the higher age group (5-9 years old) than in the lower one (2 to Ͻ5 years old): 56.9% and 76.2% respectively (P Ͻ 0.001) (Rashed S, 1993 unpublished data). Spending tends to vary with occupation, level of income and education. 3 Prevention and treatment attitudes and practices may also explain variation in spending, as may physical factors such as distance between a village and the nearest hospital. 4,5 The objective of this study is to determine what effect PITN use has on other known factors: 1) the frequency of febrile episodes, 2) treatment expenses, and 3) household expenditures for malaria prevention. Since many factors may influence these expenditures and morbidity, a multivariate analysis was used to distinguish the effect of PITN use from other factors. METHODOLOGYStudy area. The study area is situated 250 km no...

Community Perceptions on Different Delivery Mechanisms for Insecticide-Treated Bed Nets in Rural Burkina Faso

“…This was also reflected by the wish of respondents to diminish the price of the ITN. This finding confirms the results from many observations in SSA countries where lack of sufficient funds was a main reason for not buying ITN [20,[29][30][31][32][33][34][35][36]. This observation supports the arguments of those in favour for free ITN distribution systems in SSA [9].…”

Malaria prevention in The Gambia: patterns of expenditure and determinants of demand at the household level

“…While an earlier study from The Gambia found no correlation between wealth and bed net use (Aikins et al. 1993), more recent studies have reported significant financial barriers to their use (Rashed et al. 2000; Yohannes et al.…”

“…1995). In poorer rural areas, traditional methods, such as burning local herbs, are more common (Rashed et al. 2000; Nuwaha 2002; Oguonu et al.…”

“…In terms of the factors influencing expenditure on malaria prevention, it has been widely reported that expenditure depends on economic factors (Ettling et al. 1994; Rashed et al. 2000; Nuwaha 2002; Oguonu et al.…”

“…The attitudes of individuals and households towards malaria prevention also vary according to level of education, occupation, location of residence, ethnicity (Ahorlu et al. 1997; Agyepong & Manderson 1999; Rashed et al. 2000; Nuwaha 2002; Worrall et al.…”