Treatment Costs for Community-Based Management of Malaria and Pneumonia Versus Malaria Alone in Children Aged 4-59 Months in Eastern Uganda

Abstract

An integrated home and community-based management for both malaria and pneumonia using community medicine distributors  (CMDs) has been piloted in Uganda since 2010. However, little is known about the treatment cost for combined treatment compared to malaria treatment alone. This paper addresses this gap using data from a randomised controlled trial in Iganga and Mayuge districts in  Eastern Uganda.

A total of 66 CMDs, 30 from the treatment (malaria and pneumonia) and 36 in control group (malaria alone) were interviewed to obtain  data on the time spent treating children and the numbers treated per week. Using another tool, 470 caretakers were interviewed on the  costs incurred in seeking treatment from CMDs. The direct costs of the intervention were extracted from the programme documents and  the cost per case treated for the two arms were compared.

The cost per child treated in the treatment group was 1.6 times higher (US$ 7.65) compared to the control group (US$4.85). However,  indirect unit costs per child treated were about the same for the treatment (US$2.20) and control group (US$ 2.13)(P=0.704). The  incidence of severe pneumonia was about 3 times lower in the treatment compared to the control areas in the post-intervention period  (1.3% versus 4.6%). Likewise, the incidence of severe malaria was lower within the treatment group (2.8%) compared to the control (8.3%).  Compared with 'doing nothing' villages within the DSS where there was either malaria-pneumonia combined treatment or  malaria treatment alone reported a lower incidence of both severe malaria (4.4%) and severe pneumonia (2%) than those where there  was no treatment at all (17% and 22.7% respectively).

Although the direct costs for the combined treatment approach was found to be higher than malaria treatment alone, , overall it is a cost- minimising strategy compared to ‘stand alone’ vertical intervention after adjusting for indirect costs. The malaria-pneumonia combined treatment also resulted in greater health impact in terms of reducing severe pneumonia and malaria. Similarly, community-based  treatment for febrile illness, whether combine or stand alone approach, significantly reduced the incidence of severe malaria and  pneumonia. Thus, community-based combined treatment of febrile illness is a cheaper strategy compared to stand-alone interventions  and also is shown to result in greater health impacts and should be promoted. Given the fairly high indirect costs, in terms of time, borne  by the CMDs for which they are not adequately compensated, other desirable considerations for scaling up new interventions such as  equity and sustainability should also be assessed.