Preventing malaria : an evaluation of alternative methods using the cost-effectiveness technique.

Abstract

Malaria is the one of most important diseases in the world, especially in sub-Sahara Africa. This dissertation outlines the enormous burden of the disease in terms of social and economic costs in southern Africa. This dissertation assessed the range and quality of the cost-effectiveness of malaria prevention in sub-Sahara Africa. Six studies published from 1999 to 2003 are reviewed, covering insecticide treated nets, residual spraying, chemoprophylaxis for infants and environmental management. For infants, ITNs cost from US$ 2019 - $2879 per death averted and cost $ III per DALY; chemoprophylaxis cost $ 4.1 per DALY and chemoprophylaxis plus iron cost $ 5.0 per DALY. For children, ITNs cost $ 1559 per death averted, $ 57 per DALY and $ 61 per sick child averted. For non-specific age group, ITNs cost $ 29 per infection averted, and RHS $ 9. Generally all interventions assessed are cost effective use of resources. The chemoprophylaxis is the least expensive malaria prevention among cost effective malaria prevention interventions, followed by residual spraying one round a year, residual spraying two rounds a year, insecticide treated nets with net treatment only and insecticide treated nets with net provision and treatment. There are operational, managerial and financial challenges faced these most cost-effective malaria interventions. Particularly, chemoprophylaxis is faced the tremendous drug resistance potential and is not being recommended to wide use; financial constraints and the potential delaying of children's immunity acquisition lowers the cost-effectiveness of insecticide treated nets; residual spraying is a relatively simpler, faster and cheaper method, but faces political and economic pressure of concerning environmental issues, especially the use of DDT. The integrated approach of environmental management plus residual spraying could be the most cost-effective method of malaria prevention with least adverse environment effects. However, policy makers should apply their knowledge to local conditions. Further, comprehensive education programmes are needed to gain support and understanding from local communities. This would raise the cost-effectiveness of all interventions.