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.

Risk Factors of Malaria Transmission Dynamics Among Sand Mining Workers in the Kombos West Coast Region, The Gambia

“…(37) According to other study, spatial repellents (SR) can either completely stop or significantly limit the transmission of malaria. (15,38) Consistent with the findings of a previous study that looked at housing and malaria, the condition of the in-house wall was shown in this study to be a protective factor against malaria in the study region. Good house design in Uganda decreased the danger of malaria by preventing mosquito vectors from entering the country.…”

“…For instance, there is a chance that sand miners in Tanjeh and Brufut, The Gambia, would get malaria. (14,15) Additional research has demonstrated that mining regions are more susceptible to malaria, with persistent evidence of malaria vectors flourishing there, as observed in the West Kenyan highlands. (4,16) Changes in land use can have an influence on the spread of malaria, and socioeconomic and behavioural variables are among the risk factors for malaria in mining regions.…”

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

“…The analysis was conducted from the perspective of the health system; however, the incremental net costs and ICERs would be further reduced if households’ cost savings resulting from averted episodes of maternal malaria were considered. 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.…”

“…Estimates of cost per inpatient bed day were obtained from WHO 36. Further details on costs associated with MiP in project intervention districts have been published elsewhere 37…”