Economic cost of malaria in four countries in sub-Saharan Africa: A comparative analysis

Abstract

Background: Malaria remains a major cause of burden of illness in sub-Saharan Africa. The objectives of this study were to measure the costs of a malaria case in terms of costs borne by households affected and healthcare systems (either ambulatory or hospitalized) comprehensively in a number of countries in Sub-Saharan Africa, collecting data prospectively and retrospectively using a common protocol, which included data on lost productivity and unpaid time of caregivers.

Methods: We conducted community-based and health care facility-based studies on disease burden and cost of malaria disease in four sub-Sahara Africa (SSA), namely: Burkina-Faso, Ghana, Nigeria and Uganda. These were both prospective and retrospective studies that used a common protocol. The study population included children under five years old with febrile illness that met the World Health Organization’s clinical case definition for malaria. To standardize measurements of economic impact across countries and facilitate comparisons and interpretations, we expressed all direct and indirect costs in 2019. The study incorporated empirical values for most of the components of health services used, and most of their unit costs. Furthermore, it examined actual medical practices, rather than the more expensive setting of a formal prospective clinical study of laboratory confirmed malaria disease. We used the unit costs are they were in 2010 and 2011, when the field work was conducted, but then discounted them to the current year of 2019.

Findings: The total household costs were highest in Ghana and lowest in Uganda. Health systems costs are significantly higher in Nigeria. As opposed to the three other countries, indirect costs in Ghana are lower than direct costs. It was found that in general richer households tended to spend more on treating OPD and IPD cases in the four countries and a majority of Ghana respondents were insured (67%) while in the three other countries, out of pockets spending were high (from different sources), followed by subsidies from social institutions.

Conclusion: Malaria remains a major contributor the high economic burden of disease in SSA. The reasons that our estimates are higher than previous estimates could be the fact that we included as much as possible costs incurred by households before arriving at the facility where they were interviewed, comprising informal sector payment. Malaria endemic countries should not relent, but should rather redouble efforts to control and eliminate malaria as a major public health burden in SSA.