The economic costs of malaria in pregnancy: evidence from four sub-Saharan countries

Abstract

Background Malaria in pregnancy is a major public health problem in sub-Saharan Africa (SSA), which imposes a significant economic burden. We provide evidence on the costs of malaria care in pregnancy to households and the health system in four high-burden countries in SSA. Methods Household and health system economic costs associated with malaria control in pregnancy were estimated in selected areas of the Democratic Republic of Congo (DRC), Madagascar (MDG), Mozambique (MOZ) and Nigeria (NGA). An exit survey was administered to 2,031 pregnant women when leaving the antenatal care (ANC) clinic from October 2020 to June 2021. Women reported the direct and indirect costs associated to malaria prevention and treatment in pregnancy. To estimate health system costs, we interviewed health workers from 133 randomly selected health facilities. Costs were estimated using an ingredients-based approach. Results Average household costs of malaria prevention per pregnancy were USD6.33 in DRC, USD10.06 in MDG, USD15.03 in MOZ and USD13.33 in NGA. Household costs of treating an episode of uncomplicated/complicated malaria were USD22.78/USD46 in DRC, USD16.65/USD35.65 in MDG, USD30.54/USD61.25 in MOZ and USD18.92/USD44.71 in NGA, respectively. Average health system costs of malaria prevention per pregnancy were USD10.74 in DRC, USD16.95 in MDG, USD11.17 in MOZ and USD15.64 in NGA. Health system costs associated with treating an episode of uncomplicated/complicated malaria were USD4.69/USD101.41 in DRC, USD3.61/USD63.33 in MDG, USD4.68/USD83.70 in MOZ and USD4.09/USD92.64 in NGA. These estimates resulted in societal costs of malaria prevention and treatment per pregnancy of USD31.72 in DRC, USD29.77 in MDG, USD31.98 in MOZ and USD46.16 in NGA. Conclusions Malaria in pregnancy imposes a high economic burden on households and the health system. Findings emphasize the importance of investing in effective strategies that improve access to malaria control and reduce the burden of the infection in pregnancy.

Cost-effectiveness of community-based distribution of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria, and the Democratic Republic of Congo

“…Details on the economic burden of malaria on households in project areas have been analysed and discussed elsewhere. 37 …”

“…We estimated the number of clinical malaria episodes during pregnancy by using self-reported data from pregnant women in intervention areas. 37 While not ideal due to its susceptibility to bias, this approximation is unlikely to affect the CE substantially since the surrogate measure of clinical malaria contributed less than 5% to the total DALYs averted.…”

“…36 Further details on costs associated with MiP in project intervention districts have been published elsewhere. 37 …”

“…36 Further details on costs associated with MiP in project intervention districts have been published elsewhere. 37 Effectiveness Household surveys (HHS) were conducted before, during and after C-IPTp delivery, in order to measure the change in the proportion of women receiving three or more IPTp doses (IPTp3+) during their last pregnancy. Results from the HHS showed that between baseline and endline surveys, IPTp3+ coverage increased by 11.0% in MOZ, 168.6% in MDG, 207.5% in DRC and 447.5% in NGA, respectively (online supplemental table S4).…”

Leveraging malaria vaccines and mRNA technology to tackle the global inequity in pharmaceutical research and production towards disease elimination

“…This measure provided a critical facility for the international transfer of knowledge and technology for LPP of MPs for the prevention, diagnosis, and treatment of COVID-19. Given the epidemiological and economic burden of malaria in the AFR [ 12 , 13 , 32 , 33 ], a similar measure could be warranted to boost LPP and accelerate progress towards a world free of malaria. To ensure sustainability and maximize impact, any TRIPS agreement waiver on anti-malarial MPs should be coupled with adequate measures to: (i) incentivize local and international drug innovation and R&D (see domain ‘‘Research and development’’), (ii) strengthen local and continental regulatory, surveillance, and quality assurance capabilities, and (iii) boost continental trade of raw materials and APIs by leveraging the AfCFTA.…”