The impact of community delivery of intermittent preventive treatment of malaria in pregnancy on its coverage in four sub-Saharan African countries (Democratic Republic of the Congo, Madagascar, Mozambique, and Nigeria): a quasi-experimental multicentre evaluation

González, Raquel; Manun'Ebo, Manu F; Meremikwu, Martin; Rabeza, Victor; Sacoor, Charfudin; Figueroa-Romero, Antía; Arikpo, Iwara; Macete, Eusébio; Ndombe, Didier Mbombo; Ramananjato, Ranto; LIach, Mireia; Pons‐Duran, Clara; Sanz, Sergi; Ramírez, Máximo; Cirera, Laia; Maly, Christina; Roman, Elaine; Pagnoni, Franco; Menéndez, Clara

doi:10.1016/s2214-109x(23)00051-7

“…Indirect costs reflected the value of the time lost due to attending an ANC visit. The average household cost of malaria prevention per pregnancy was calculated by multiplying the cost of providing malaria prevention services through an ANC visit by the average number of IPTp doses received 14 .…”

Section: Household Costsmentioning

confidence: 99%

“…Reference prices for drugs and mosquito nets were taken from WHO and the Global Fund procurement prices. The average prevention costs per pregnancy were approximated by multiplying the costs of an ANC visit by the average number of IPTp doses received per women in intervention areas 14 .…”

Section: Health System Costsmentioning

confidence: 99%

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

Cirera

¹

,

Sacoor

²

,

Meremikwu

³

et al. 2023

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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.

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“…These findings indicate that although IPTi has been successfully integrated into the EPI program in Sierra Leone, some limitations still exist that represent missed opportunities for some children attending the EPI scheme who do not receive the recommended malaria prevention at the same visit. Similarly, regarding malaria control in pregnancy it has been also reported missed opportunities in the proportion of pregnant women receiving intermittent preventive treatment in pregnancy (IPTp), being systematically lower than the proportion of women attending the antenatal clinic visit [ 17 ]. As with IPTp, some reasons may explain the observed misalignment between IPTi uptake and the immunizations administered, namely, SP stock-outs, children -in the case of IPTi-, presenting with acute diseases (such as clinical malaria), lack of equipment or water to administer the drug, or caretaker´s refusal, or lack of staff commitment.…”

Section: Discussionmentioning

confidence: 99%

Coverage of intermittent preventive treatment of malaria in infants after four years of implementation in Sierra Leone

Fombah

¹

,

Chen

²

,

Owusu-Kyei

³

et al. 2023

Malar J

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Background Intermittent Preventive Treatment of malaria in infants (IPTi) is a malaria control strategy consisting of the administration of an anti-malarial drug alongside routine immunizations. So far, this is being implemented nationwide in Sierra Leone only. IPTi has been renamed as Perennial Malaria Chemoprevention -PMC-, accounting for its recently recommended expansion into the second year of life. Before starting a pilot implementation on PMC, the currently implemented strategy and malaria prevalence were assessed in young children in selected areas of Sierra Leone. Methods A cross-sectional, community-based, multi-stage cluster household survey was conducted from November to December 2021 in selected districts of the Northern and northwestern provinces of Sierra Leone among 10–23 months old children, whose caretakers gave written informed consent to participate in the survey. Coverage of IPTi and malaria prevalence—assessed with rapid diagnostic tests—were calculated using percentages and 95% confidence intervals weighted for the sampling design and adjusted for non-response within clusters. Factors associated with RDT + and iPTi coverage were also assessed. Results A total of 720 children were recruited. Coverage of three IPTi doses was 50.57% (368/707; 95% CI 45.38–55.75), while prevalence of malaria infection was 28.19% (95% CI 24.81–31.84). Most children had received IPTi1 (80.26%, 574/707; 95% CI 75.30–84.44), and IPTi2 (80.09%, 577/707; 95% CI 76.30–83.40) and over half of the children also received IPTi3 (57.72%, 420/707; 95% CI 53.20–62.11). The uptake of each IPTi dose was lower than that of the vaccines administered at the same timepoint at all contacts. Conclusion In Sierra Leone, half of the children received the three recommended doses of IPTi indicating an increase in its uptake compared to previous data of just a third of children receiving the intervention. However, efforts need to be made in improving IPTi coverage, especially in the planned expansion of the strategy into the second year of life following recent WHO guidelines.

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“…The study areas were heterogeneous in terms of the demographic and health profiles, but all them were endemic of malaria, with the disease being among the leading causes of maternal and child mortality 11 . Further details on the study setting have been published elsewhere 12 , 13 .…”

Section: Methodsmentioning

confidence: 99%

“…While direct costs reflect the financial costs, the economic costs include both direct and direct costs. The average household cost of malaria prevention per pregnancy was calculated by multiplying the cost of providing malaria prevention services through an ANC visit by the average number of IPTp doses received 12 .…”

Section: Methodsmentioning

confidence: 99%

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

Cirera

¹

,

Sacoor

²

,

Meremikwu

³

et al. 2023

Self Cite

View full text Add to dashboard Cite

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.

show abstract

The impact of community delivery of intermittent preventive treatment of malaria in pregnancy on its coverage in four sub-Saharan African countries (Democratic Republic of the Congo, Madagascar, Mozambique, and Nigeria): a quasi-experimental multicentre evaluation

Cited by 19 publications

References 23 publications

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

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

Coverage of intermittent preventive treatment of malaria in infants after four years of implementation in Sierra Leone

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

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