Dataset Information

Cost-of-illness of cholera to households and health facilities in rural Malawi.

ABSTRACT: Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

SUBMITTER: Ilboudo PG

PROVIDER: S-EPMC5608291 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Cost-of-illness of cholera to households and health facilities in rural Malawi.

Ilboudo Patrick G PG Huang Xiao Xian XX Ngwira Bagrey B Mwanyungwe Abel A Mogasale Vittal V Mengel Martin A MA Cavailler Philippe P Gessner Bradford D BD Le Gargasson Jean-Bernard JB

PloS one 20170921 9

Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional ...[more]

PMID: 28934285

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Project description:BackgroundThis study explored the role of health facility availability as it relates to maternal and newborn PNC use in rural Malawi.MethodsMalawi Demographic and Health Survey (MDHS) 2015-16 data, MDHS 2015-16 household cluster GPS data, Malawi Service Provision Assessment (MSPA) 2013-14 data and MSPA 2013-14 facility GPS data were used. Household clusters were spatially linked with facilities using buffers. Descriptive analyses were performed and generalized estimating equations (GEE) were used to determine the effects of having different types of facilities at varying distances from household clusters on receipt of maternal and newborn PNC in rural Malawi.ResultsIn rural Malawi, around 96% of women had facilities providing PNC within 10?km of where they live. Among women who have clinic-level facilities within 5?km of where they live, around 25% had clinic-level facilities that provide PNC. For rural women who gave birth in the past 5?years preceding the survey, only about 3% received maternal PNC within 24?h and about 16% received maternal PNC within the first week. As for newborn PNC, 3% of newborns had PNC within 24?h and about 26% had newborn PNC within the first week. PNC mostly took place at facilities (94% for women and 95% for newborns). For women who delivered at home, having a health center providing PNC within 5?km was positively associated with maternal and newborn PNC. For women who delivered at facilities, having a health center providing PNC within 5?km was positively associated with maternal PNC and having a health center providing PNC between 5?km and 10?km was positively associated with both maternal and newborn PNC. Regardless of the place of delivery and distance band, having a clinic-level facility providing PNC did not have significant positive effects on maternal and newborn PNC.ConclusionsProviders should be trained to perform quality PNC at all facilities. It would also be important to address concerns related to health workers. Lastly, it would be key to increase community awareness about the importance of seeking timely PNC and about the utility of lower-level facilities for receiving preventative PNC.

Project description:Existing literature on the impacts of adult illness on household labour supply and income in low- and middle-income countries shows that adverse health conditions significantly affect household labour supply, work participation and earnings. Most of the studies, however, are not equipped to distinguish between short- and long-term consequences of adult illness. We measured the impact of adult illness on household employment outcomes both in the short- and the long-run, using a unique longitudinal data set from rural India.We used two waves of India Human Development Survey (1993-94 and 2004-05) with a balanced panel of 10?726 households to assess short-run (in the year of the occurrence of adult illness) and long-run (after 11 years of the occurrence of adult illness) effects of major illness of adult household members aged 15-64 years on household employment outcomes, using multiple matching methods: nearest-neighbor matching and inverse probability weighting following propensity score matching, and coarsened exact matching to compare employment outcomes to a set of matched control households.Rural households affected by adult illness experienced declines in workforce participation rate by 1-3%, wage employment by 4-15 days, and wage-earnings by Indian Rupee (INR) 374 to INR 837 compared to the matched control households in the short-run. In response, adult non-sick members of the affected households increased their workforce participation sharply by 14-16% to compensate for shortfalls in the short-run. In the long-run, workforce participation rate of the affected households also declined by nearly 1-3%. The long-run declines in wage-days and wage-earnings were small and not always statistically significant across the methods. However, long-run workforce participation rate of non-sick adults were smaller (4-6%) compared to short-run, but still statistically significant.The long-term effects were smaller in absolute magnitude than those of the short-run. This suggests coping and adjustments by the affected households using this 11-year longer time-span in a manner that helps to ameliorate the immediate impacts of adult illness. Our study also reiterates the importance of improving financial access to health services as well as access to social security benefits for the illness-affected households in rural India both in the short- and long-run.

Project description:BackgroundTo further reduce malaria burden, identification of areas with highest burden for targeted interventions needs to occur. Routine health information has the potential to indicate where and when clinical malaria occurs the most. Developing countries mostly use paper-based data systems however they are error-prone as they require manual aggregation, tallying and transferring of data. Piloting was done using electronic data capture (EDC) with a cheap and user friendly software in rural Malawian primary healthcare setting to improve the quality of health records.MethodsAudit and feedback tools from the Joanna Briggs Institute (Practical Application of Clinical Evidence System and Getting Research into Practice) were used in four primary healthcare facilities. Using this approach, the best available evidence for a malaria information system (MIS) was identified. Baseline audit of the existing MIS was conducted in the facilities based on available best practice for MIS; this included ensuring data consistency and completeness in MIS by sampling 25 random records of malaria positive cases. Implementation of an adapted evidence-based EDC system using tablets on an OpenDataKit platform was done. An end line audit following implementation was then conducted. Users had interviews on experiences and challenges concerning EDC at the beginning and end of the survey.ResultsThe existing MIS was paper-based, occupied huge storage space, had some data losses due to torn out papers and were illegible in some facilities. The existing MIS did not have documentation of necessary parameters, such as malaria deaths and treatment within 14 days. Training manuals and modules were absent. One health centre solely had data completeness and consistency at 100% of the malaria-positive sampled records. Data completeness and consistency rose to 100% with readily available records containing information on recent malaria treatment. Interview findings at the end of the survey showed that EDC was acceptable among users and they agreed that the tablets and the OpenDataKit were easy to use, improved productivity and quality of care.ConclusionsImprovement of data quality and use in the Malawian rural facilities was achieved through the introduction of EDC using OpenDataKit. Health workers in the facilities showed satisfaction with the use of EDC.

Project description:BACKGROUND:Reducing the burden of malaria highly depends on access to prompt and effective malaria diagnosis and treatment. The aim of this study was to identify challenges affecting prompt access to effective uncomplicated malaria case management in children below 10?years old in rural primary health care facilities in Malawi. METHODS:A cross sectional health facility survey was conducted in six primary health facilities in Chikhwawa district, Malawi. Officers-in-charge of health facilities were interviewed on availability of staff, supplies and drugs. All consecutive children presenting at the facility with fever or suspected malaria, aged 6?months to 10?years old, were eligible to participate in exit interviews. Exit interviews with participants' guardians assessed duration of illness, demographic information and distance travelled. Adherence to recommended malaria case management guidelines included performing malaria rapid diagnostic tests (mRDTs) in children with fever or suspected malaria and prescribing recommended weight-based dose of artemether-lumefantrine (AL) when mRDT was positive. Multivariate logistic regression was used to determine factors associated with prompt care seeking within 24?h of onset of illness. RESULTS:Health facilities were staffed by at least two health workers. Of 265 children screened, nine were excluded due to severe illness. Twenty-one percent of children presenting at a health facility with fever were not tested for malaria. Adherence to positive and negative mRDT results for those tested was 99.4, 95% CI [98.1-100] and 97, 95% CI [88.9-100], respectively. AL was prescribed as recommended by weight in 152 children (92.2%). Temporary stock outs of AL occurred in five of six facilities. In total, 146 (57, 95% CI [52.7-64.1]) guardians of patients sought care within 24?h after fever onset. Children aged 5 to 10?years were less likely to present within 24?h of fever onset than children below 5?years of age (unadjusted odds ratio 0.40, 95% CI [0.2-0.7]). CONCLUSION:Adherence to malaria diagnosis and treatment guidelines was high. However, delayed care seeking and stock outs may affect prompt and effective malaria case management. Further qualitative work is required to determine, and address factors associated with delay in care seeking for fever.

Project description:BackgroundEnvironmental health services (EHS) in healthcare facilities (HCFs) are critical for providing a safe, functional healthcare environment, but little is known about their costs. Poor understanding of costs impedes progress towards universal access of EHS in HCFs. We developed frameworks of essential expenses required to provide EHS and conducted an ex-post financial analysis of EHS in a network of medical research and training facilities in Lilongwe, Malawi, serving an estimated 42,000 patients annually through seven outpatient buildings.MethodsWe estimated the cost of providing the following EHS: water, sanitation, hygiene, personal protective equipment use at the point of care, waste management, cleaning, laundry, and vector control. We developed frameworks of essential outputs and inputs for each EHS through review of international guidelines and standards, which we used to identify expenses required for EHS delivery and evaluate the completeness of costs data in our case study. For costing, we use a mixed-methods approach, applying qualitative interviews to understand facility context and review of electronic records to determine costs. We calculated initial costs to establish EHS and annual operations and maintenance.ResultsAvailable records contained little information on the upfront, capital costs associated with establishing EHS. Annual operations and maintenance totaled USD 220,427 for all EHS across all facilities (USD 5.21 per patient encounter), although costs of many essential inputs were missing from records. Annual operations and maintenance costs were highest for cleaning (USD 69,372) and waste management (USD 46,752).DiscussionMissing expenses suggests that documented costs are substantial underestimates. Costs to establish services were missing predominantly because purchases pre-dated electronic records. Annual operations and maintenance costs were incomplete primarily because administrative records did not record sufficient detail to disaggregate and attribute expenses.ConclusionsElectronic health information systems have potential to support efficient data collection. However, we found that existing records systems were decentralized and poorly suited to identify EHS costs. Our research suggests a need to better code and disaggregate EHS expenses to properly leverage records for costing. Frameworks developed in this study are a potential tool to develop more accurate estimates of the cost of providing EHS in HCFs.

Project description:BackgroundThe World Health Organization (WHO) recommends oral cholera vaccines (OCVs) as a supplementary tool to conventional prevention of cholera. Dukoral, a killed whole-cell two-dose OCV, was used in a mass vaccination campaign in 2009 in Zanzibar. Public and private costs of illness (COI) due to endemic cholera and costs of the mass vaccination campaign were estimated to assess the cost-effectiveness of OCV for this particular campaign from both the health care provider and the societal perspective.Methodology/principal findingsPublic and private COI were obtained from interviews with local experts, with patients from three outbreaks and from reports and record review. Cost data for the vaccination campaign were collected based on actual expenditure and planned budget data. A static cohort of 50,000 individuals was examined, including herd protection. Primary outcome measures were incremental cost-effectiveness ratios (ICER) per death, per case and per disability-adjusted life-year (DALY) averted. One-way sensitivity and threshold analyses were conducted. The ICER was evaluated with regard to WHO criteria for cost-effectiveness. Base-case ICERs were USD 750,000 per death averted, USD 6,000 per case averted and USD 30,000 per DALY averted, without differences between the health care provider and the societal perspective. Threshold analyses using Shanchol and assuming high incidence and case-fatality rate indicated that the purchase price per course would have to be as low as USD 1.2 to render the mass vaccination campaign cost-effective from a health care provider perspective (societal perspective: USD 1.3).Conclusions/significanceBased on empirical and site-specific cost and effectiveness data from Zanzibar, the 2009 mass vaccination campaign was cost-ineffective mainly due to the relatively high OCV purchase price and a relatively low incidence. However, mass vaccination campaigns in Zanzibar to control endemic cholera may meet criteria for cost-effectiveness under certain circumstances, especially in high-incidence areas and at OCV prices below USD 1.3.

Dataset Information

Cost-of-illness of cholera to households and health facilities in rural Malawi.

Publications

Cost-of-illness of cholera to households and health facilities in rural Malawi.

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