Malaria Results

7/27/2019 Malaria Results

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Results:

This study has attempted to estimate the cost of seeking and obtainingtreatment for This study estimated both direct and indirect cost of illnessat the individual and household levelsThere is low use of preventive measures against malaria by households inthis study, reflecting the practice in other malaria endemic countries oflow prevention uptake by households, (nigeria), where some studiesreported a net use less than 10% among households where??(care seekingand cost)Our study reported a preventive measure non-use higher than many ofthe other countries, where the percent of households not using any

protective measures against malaria ranges from 23%in where??(malaria16) to: = 18.6% to 2.3% in Kenya determinants o f mosquito avoidance)

The relative higher uptake of preventive measures by higher incomeclasses compared to lower income groups reported in this study issupported by the evidence that one of the important determinants ofmalaria preventive measures use is affordabilityreference. Add more ref.relationSES and malaria If the poorer households, motivated by the similar urge fora peaceful night sleep as their richer counterparts, insist on paying out of

pocket for the relatively more expensive protective methods , then it iseasy to see that just the act of attempting to prevent mosquitoes from

biting may be helping to keep these households from improving their

well-being as well as their health status. determinants o f mosquitoevidenceis provided that even among the poorest, people avoid mosquitoes if theycan afford it determinants o f mosquitoThis call into attention the importance of finding of mechanisms toexpand the coverage by preventive measures to poorer sectors of the

population, such as social marketing or subsidies for bed net and otherpreventive methods, through partnerships with donors, non-governmentalorganizations and the private sector. Such mechanisms- especially socialmarketing programmes- had proved their success in many malaria

endemic countries in improving preventive measure use by individualsand households eterminants o f mosquito avoidance)(realatioan SES and malaria))

The low use of preventive measures even among the richest group attractthe attention for another determinant of low use of preventive measuresnamely the lack of awareness by the households about the devastatingimpacts of malaria, especially including its socio-economicimpact(nigeria) this necessitates that in addition to insuring affordability,intensive health education programmes should be directed towards the

population to increase their awareness and thus their involvement inmalaria control measures.There is now ample evidence that sustainable


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reductions in the malaria burden depend not only on the use of effectivetools but also on the successful integration of behavioural change inactivities at the community level.(economic and social council)Although not elicited here, one of the factors that may have limited the

use of preventive methods is the unavailability of these methods- such asimpregnated bed nets -on a large scale in the State. Many of therespondents in this study expressed their ignorance about this highly costeffective preventive item. This problem should be tackled even beforeany of the above mentioned recommended interventions

Cuz of low use of prevention:can be explained by the relatevly good understanding of malaria eitiologyand finacial resourse.

Methods64 (52%) Fire - Bed net 42 (32%) - 5 (4%) Mosquito coil - 2 (2%) House-screen - None 29 (23%) (malaria 16)

The result reported by this study in that there was no difference in malaria incidencebetween the income group is supported by the evidence that malaria incidence bysocioeconomic groups within countries does not show any clear poor-rich gradient (ec

burden on households)(relation SES and malaria)other ref.Malaria, unlike diseases

resulting from poverty, does not discriminate between rich and poor victims. The lackof consistent socio-economic differentials in malaria incidence is not necessarilycounterintuitive given the epidemiology of malaria transmission. realatioan SESand malaria))

Malaria cases:Cross tabs presence of malaria and rural urban

Care seeking and its reasons:

Not only the proportion who delayed taking action about their illnesswere low ,but also the average period of delay was considerably lowerthan what was reported from other countries, where rates as high as 83%and delays for periods as long as a week were reported(rev seeking)The high use rate of formal health services and the low rate of selftreatment, reflected by this study differs from the trend of seeking carefor malaria in other malarial countries(inequalities among the poor)(malaria 16)(matale)care seeking and cos, where it is reported that44% ofthe self treatment rates in African countries were above 50 %( revseeking) with rates as high as 97%(matale) Even rates of formal healthservices of 40% are considered by some authors as high .(inequality

among the poor)


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The swiftness of taking action, low level of self treatment and high levelof facility use can be explained by the wide accessibility to formal healthservices in Khartoum State, these servses are provided by thegovernment, non-for-prophet-private sector and for-prophet-private sector

(care seeking and cost)In addition to their abundance these health facilities are established withinresidential areas and are close to the homes of most affected people. Thishigh access to health services may also be behind the high proportion ofconfirmed malaria cases noticed during this study. Also this is most

probably the reason for the high proportion of respondents who had usedno transportation means to reach their disteny while seeking care.Among the small proportion of those who took an action other thanseeking care from the formal health sector, financial barriers were

mentioned as one of the main reasons, Most studies found the financialcosts the most significant determinants of care seeking (care seeking andcost)(realatioan SES and malaria)).(willingness to pay Nepal) (rev of behavioral

issues to malaria control).(variations in burkina). Thus despite the high use rateof health services, this indicates that still some sectors of the communitycannot afford the cost of the health care, it should be noted here thatamong those who had not delayed their care seeking, or used the formalhealth sector, some might have been forced to use some of the copingmechanisms such as borrowing or selling some assets to secure thenecessary funds for treatment.

The low use of traditional medicine to treat malaria can be explained bythat the population is knowledgeable about the disease and its medicaltreatment. A number of studies suggest that the majority of peoplerecognize the value of modern drugs in the treatment of malaria.(revseeking) the few who treated their illness by traditional medicine, orresorted to it after failure of anti malaria treatment, had most probablysuffered from diseases other than malaria.

Type of facility used: the high utilization rate of governmental and non-

for-profit private sector compared to for-profit-private sector wasobviously due to the high accessibility and low cost of the formers, the

provision of malaria drugs through revolving drug funds at prices belowthose of private sector, had reduced the total financial cost of a healthcare visit and increased health care utilization [15]. As was the case of inother African countries. (variation in burkina)(care seeking and cost)The rate of utilization of private health facilities reported by this study, islow compared to what was reported by some studies such as the oneconducted in Sri Lanka, where 25% of the patients sought care from the

private sector(matale)


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No difference between rich and power in demand.

The finding that there was no evidence of gross lack of utilization ofhealth care by people in lower income households is supported by studiesin Thailand, Malaysia and Philippines which found no impact of income

on the demand for health care.(benin). (inequality in thailand. On the otherhand in Benin it was found that the households in the upper social classmay have a greater chance of reporting a malaria patient()benin)This result shows the importance of factors other than costs indetermining the choice of a facility, the tendency of the lower incomeclasses to use the for profit private sector as their richer counterparts isdue as reported by the respondents to the perceived high quality of the

private sector, a fact reported by matale and Ghana in that people areprepared to pay higher for the high quality health care(matale)(ghana)

this should emphasize two important points:First: Improving the quality of care at public facilities in order to attractpatients from the private to the public sector and reduce direct costs.

Second: the importance of private sector provision for treatment ofmalaria at the household level. This suggests that policy makers need to

pay special attention to private as well as public providers of serviceswhen formulating control strategies and measures.The rate of compliance is high compared to other malaria endemiccountries , where the rate of completion of ant malarias treatment regimenis known to be poor, noncompliance is widely acknowledged problem,

despite the limiting factors of assessing compliance through subjectingmeans(care seeking and cost)However the high under dosing rate associated with self treatment duringthis study emphasize the importance of intensification of public educationto discourage self medication which leads to misuse of antimalara drugsand thereby promote resistance of the malaria parasite to drugs thusincreasing the cost of treatment.The main reason for ignoring the illness for the majority (77.8%) of thenine persons who ignored the illness was the lack of money.(15)

************cost calculation:cost of illness studies face difficulties in how the data should be

presented, in particular whether measures of central tendency best reflector represent the cost burdens facing the study population. Illness andillness costs are usually distributed very unevenly across households,with a minority incurring very high costs, so measures of central tendencyconceal wide variations in cost burdens. The use of mean cost figures, in

particular, often exaggerates the cost burdens faced by most households

because a minority of high values pull the mean above the median.Median figures may therefore reflect more accurately the costs facing the


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majority of households, but in many studies only the mean is presented.ec burden on households)

The mean cost of preventive measures against malaria during last year

per household was 2944SD(5517) the median was 1400SD or US$ 5.4per household, one of the one of the reasons making comparison withother countries difficult is the use of different unit costs, most studiesused an average cost per month this is more suitable for countries with allyear malaria transmission where the population had to use preventivemeasures all through the year. Converting this value into a monthlyaverage we can observe it is laying towards the lower limit of the range of

per month household average expenditure on malaria prevention from$0.024 to $15 mentioned by **** in his review article .(rev in africa)

The mean Direct cost to treat malaria morbidity per household per monthwas found to be 2710SD(2191)%10.4 the median was 1100SD equivalenttoUS$4.2. This lies also towards the lower limit of the range mentioned

by for average monthly expenditure which is $ 1.88 to $ 26 perhousehold.(rev in africa),

The mean direct cost for treating malaria per patient was found to be1391SD(1334)US$5.35 median 1070 SD US$ 4.1 when including thenutrient foods and drinks the average cost was 1972 SD (2662) themedian was 1300 SD. This slightly lower than what Hanan et al found in

Wad Medni (US$5.2)(hanan) both differs greatly from what Obina foundin the State during 2002 (US$10)

As was found by this study, many other studies had shown that a largeproportion of spending on malaria goes towards pharmaceuticals,(variationin burkina) ec burden on households.( HH expenditure on prevention andtreatment for example in Ghana they accounted for 62% of direct costsfor mild malaria and 70% for severe malaria. ec burden on households) itaccounted for 34.9% of all treatment costs in Burkina Faso.( HH

expenditure on prevention and treatment). The fact the proportionreported by our study is less compared to these studies is that chloroquinewhich is a cheap drug is still effective in treating malaria, whereas inthese countries development of resistance to chloroquine had requiredmore potent and therefore more expensive drugs than chloroquine(ghana

poverity SES and prevention:

The significant difference in annual average malaria expenditure issupported by the fact that one of the key determinants of expenditure on

preventive measures is incomewillingness to pay nepal)realatioan SES and

malaria)) determinants o f mosquito avoidance) .(rev seeking)


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Also as was found by this study, authors have found positive correlationbetween expenditure on malaria prevention and incomerealatioan SESand malaria)).(microecomomic app)

however although the poor expend less than the rich in absolute terms

theypay relatively higher shares of their income***** reported that when the poor do choose to invest in malariaprevention, they suffer a greater relative burden of this expenditure.realatioan SES and malaria) in Malawi, Estimated annual expenditure on

prevention comprised 0.9% of annual income in very low incomehouseholds (VLYH) and 0.5% of annual income in low to high incomehouseholds (LHYH)1 (realatioan SES and malaria))

******88As was reported by other studies this study proved the positive correlation betweenincome and treatment expenditure(realatioan SES and malaria.In absolute termsthe poor households in general expend less on treatment than richer households, )(ecburden on HH) (economic and demographic researchdue to lack of access,inability to pay, greater use of public services)(ec burden on HH)

It should be noted that The correlation is stronger between preventive expenditure andincome, authors pointed out that more variables influenced prevention practices thaninfluenced average treatment expenditure for febrile illness because the nature ofillness is the principal determinant of expenditure on a particular illness episode.(realatioan SES and malaria))

Two explanations are behind the difference between urban and rural areas; first thehigh accessibility to private facilities in urban areas, in Malawi treatment. Expensesfor private consultation, were found to be significantly higher in urban areas and the

proportion of total treatment costs accounted for by private consultation were 11% ofrural and 48% of urban total treatment expenditure(realatioan SES and malaria))

Secondly: the prevalence of malaria is generally higher in rural areasEvidence has shown that even the unit costs are not high,the direct cost will be high

due to the very high prevalence( malaria in new colonization project brazil) . (revseeking)many studies in developing countries find that families spend between 2-5% of theirincome on private medical care and drugs .(economic and demographic research)

although the amount is less for the poor in absolute terms the percentageis the same or even higher than for the rich evidence shows that the directcosts of health care are regressive, imposing a greater burden (in terms of% of income) on poor families than on better-off families (HI accsess)) ec

burden on households) .(microecomomic app) (economic and

demographic research) (inquality in thailand).(family out of pocket expend)


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thus the burden of malaria treatment expenditure is likely to be greaterfor poorer than less poor households. (realatioan SES and malaria))in Malawi, it was found that the overall direct expenditure on treatment ofmalaria illness the overall direct expenditure on treatment of malaria

illness constitute 28% of annual income among very low-incomehouseholds and 2% of annual income) among low to high-incomehouseholds despite similar levels of expenditure(nigeria) ec burden onhouseholds) 64% and 29% of households income was spent by poorestquintile in Kenya and Tanzania respectively on a typical illness episodescompared 1% for the highest in both countries. .(economic anddemographic research) in Benin it was found that total treatmentexpenditure accounted for a slightly higher proportion of annualhousehold income in rural (3.3%) compared to urban (2.4%)

households(realatioan SES and malaria))bSuch high cost burdens for the poor are likely to trigger asset orborrowing strategies, and a recent review of malaria and poverty hasargued that malaria prevention and treatment programmes need to havemore of an equity focus and better targeted to the poorec burden onhouseholds)

Comparing between different residential areas in the state the averageexpenditure for malaria prevention was estimated for the urban areas to

be 3391SD(6115), in the rural areas it was 2301SD(3591), and in the

camps it was 779SD(464). (figure 32)Using the log of the prevention costit was found that the average expenditure for malaria prevention in theurban households was significantly higher than that in the camps(p


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The potential impact of how health systems are financed on thewellbeing of households, particularly poor households, has affectedthe design of health systems and insurance mechanisms incountries as diverse as the USA, Australia, India, and Indonesia.(household catastrophic expend)

***** reported that the triad of poverty, health-service access and use,and the failure of social mechanisms to pool financial risks account formost of the variation across countries in the level of catastrophicexpenditure. Catastrophic payments are the biggest issue when all threeof these factors are strong. Therefore, it is expected to see high rates ofcatastrophic spending in countries with high rates of poverty, groupsexcluded from financial risk protection mechanisms such as socialinsurance, and moderate to high levels of health-care access and use. .

(household catastrophic expend)

High coverage by services and OOP:Interpretation People, particularly in poor households, can beprotected from catastrophic health expenditures by reducing ahealth systems reliance on out-of-pocket payments and providingmore financial risk protection. Increase in the availability of healthservices is critical to improving health in poor countries, but thisapproach could raise the proportion of households facingcatastrophic expenditure; risk protection policies would beespecially important in this situation. (household catastrophic

expendTo reduce or mitigate direct medical costs, the service delivery weaknesses thatincrease direct costs to households need to be addressed, for example:Expand coverage of tax- or insurance-based financing systems to protect poorhouseholds from out-of-pocket payments for health care, since these paymentsimpose significant barriers to access and considerable cost burdens on the poor.ec burden on households

heath insurance for OOP and access:

National health systems can be financed in ways that protecthouseholds from catastrophic spending and provide access toneeded services. The most straightforward approach is to reduceout-of-pocket spending through the development of social insuranceor funding through general taxes. (household catastrophic expend)User fees worse than HI:

Both reasons are important for arguing that health systems arebetter financed through prepayment mechanisms such as socialinsurance and general taxation than through user-fees. . (householdcatastrophic expend)

As was expected self treatment had a lower cost per patient than visting ahealth the fact that those who did not consult the formal health system as

their first action where forced to do so as a second action increasing the


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cost significantly, this stresses the importance of educating the populationin order to improve their care seeking to the bestThe variations in average cost are a function of the source of care in thatthere were substantial differences in fees charged by different providers

and travel costs to each source of treatment.(matale) it is expected thataverage cost per patient to be high for those who consulted private

providers than those who went to a governmental or NGO organizationfacility.****** found that individuals treated at private clinics paidsignificantly more for malaria treatment than those treated at publichealth facilities (care seeking and cost)

Also ****** found that patients who had received treatment only fromprivate western sources had the highest average cost of treatment (matale)Add hanan result and refernce

The mean direct cost per patient for those with the health insurancecorporation coverage was 1195 SD(1278), for those with private healthinsurance coverage it was 1521 SD( 1724) and for those with no coverageit was 1423SD(1317) table 16.For those who took self treatment the mean direct cost per patient was327 SD (311), for those who did blood investigation with no consultationit was 1226 (978), for those who went to health facility it was 1433SD

(1307) , for those who went to a traditional practitioner it was 420 SD(362), and for those who did two actions it was 2122 SD (1856) table 17.For those who went to governmental hospital the mean direct cost per

patient was 1250 SD (913), for those who went to governmental healthcenter it was 1090 SD (797), for those who went to a dispensary it was686 SD (302), for those who went to NGO center it was 1176 SD (727),for those who went to a private clinic it was 3088 SD (2236) for thosewho went to a private hospital it was 1850 SD (1228).table 18

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Malaria Results