Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana

Edith Patouillard, Lesong Conteh, Jayne Webster, Margaret Kweku, Daniel Chandramohan, Brian Greenwood, Edith Patouillard, Lesong Conteh, Jayne Webster, Margaret Kweku, Daniel Chandramohan, Brian Greenwood

Abstract

Background: Intermittent preventive treatment of malaria in children (IPTc) involves the administration of a course of anti-malarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected. IPTc provides a high level of protection against uncomplicated and severe malaria, with monthly sulphadoxine-pyrimethamine plus amodiaquine (SP&AQ) and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens. A key challenge is the identification of a cost-effective delivery strategy.

Methods: A community randomized trial was undertaken in Jasikan district, Ghana to assess IPTc effectiveness and costs using SP&AQ delivered in three different ways. Twelve villages were randomly selected to receive IPTc from village health workers (VHWs) or facility-based nurses working at health centres' outpatient departments (OPD) or EPI outreach clinics. Children aged 3 to 59 months-old received one IPT course (three doses) in May, June, September and October. Effectiveness was measured in terms of children covered and adherent to a course and delivery costs were calculated in financial and economic terms using an ingredient approach from the provider perspective.

Results: The economic cost per child receiving at least the first dose of all 4 courses was US$4.58 when IPTc was delivered by VHWs, US$4.93 by OPD nurses and US$ 5.65 by EPI nurses. The unit economic cost of receiving all 3 doses of all 4 courses was US$7.56 and US$8.51 when IPTc was delivered by VHWs or facility-based nurses respectively. The main cost driver for the VHW delivery was supervision, reflecting resources used for travelling to more remote communities rather than more intense supervision, and for OPD and EPI delivery, it was the opportunity cost of the time spent by nurses in dispensing IPTc.

Conclusions: VHWs achieve higher IPTc coverage and adherence at lower costs than facility-based nurses in Jasikan district, Ghana.

Trial registration: ClinicalTrials.gov NCT00119132.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. World Health Organization. Technical Expert Group meeting on intermittent preventive treatment in pregnancy (IPTp) Geneva: 2007.
    1. World Health Organization. WHO Policy recommendation on Intermittent Preventive Treatment during infancy with sulphadoxine-pyrimethamine (SP-IPTi) for Plasmodium falciparum malaria control in Africa. Geneva: 2010.
    1. Wilson AL. A Systematic Review and Meta-Analysis of the Efficacy and Safety of Intermittent Preventive Treatment of Malaria in Children (IPTc). PLoS One. 2011;6:e16976.
    1. Conteh L, Patouillard E, Kweku M, Legood R, Greenwood B, et al. Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine & artesunate or sulphadoxine-pyrimethamine in Ghanaian children. PLoS One 2010
    1. Kweku M, Webster J, Adjuik M, Abudey S, Greenwood B, et al. Options for the delivery of intermittent preventive treatment for malaria to children: a community randomised trial. PLoS One. 2009;4:e7256.
    1. Bojang K, Akor F, Conteh L, Webb E, Bittaye O, et al. Two strategies for the delivery of IPTc in an area of seasonal malaria transmission in The Gambia: a randomised controlled trial. PLos Med. 2011;8
    1. Philipps M, Mills A. Guidelines for cost-effectiveness analysis of vector control. Geneva: PEEM Secretariat World Health Organization; 1993.
    1. Management Science for Health. 2009. International Drug Price Indicator Guide.
    1. Manzi F, Hutton G, Schellenberg J, Tanner M, Alonso P, et al. From strategy development to routine implementation: the cost of Intermittent Preventive Treatment in Infants for malaria control. BMC Health Serv Res. 2008;8:165.
    1. Dicko A, Toure SO, Traore M, Sagara I, Toure OB, et al. Increase in EPI vaccines coverage after implementation of intermittent preventive treatment of malaria in infant with Sulfadoxine -pyrimethamine in the district of Kolokani, Mali: Results from a cluster randomized control trial. BMC Public Health. 2011;11:573.
    1. Chandramohan D, Webster J, Smith L, Awine T, Owusu-Agyei S, et al. Is the Expanded Programme on Immunisation the most appropriate delivery system for intermittent preventive treatment of malaria in West Africa? Trop Med Int Health. 2007;12:743–750.
    1. Noor AM, Amin AA, Akhwale WS, Snow RW. Increasing coverage and decreasing inequity in insecticide-treated bed net use among rural Kenyan children. PLoS Med. 2007;4:e255.
    1. Adome RO, Whyte SR, Hardon A. Popular pills: community drug use in Uganda. Amsterdam: Het Spinhuis Publishers; 1996.
    1. van der Geest S. Self-care and the informal sale of drugs in south Cameroon. Soc Sci Med. 1987;25:293–305.
    1. Molyneux CS, Mung'Ala-Odera V, Harpham T, Snow RW. Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya. Trop Med Int Health. 1999;4:836–845.
    1. Njau JD, Goodman C, Kachur SP, Palmer N, Khatib RA, et al. Fever treatment and household wealth: the challenge posed for rolling out combination therapy for malaria. Trop Med Int Health. 2006;11:299–313.
    1. McCombie SC. Treatment seeking for malaria: a review of recent research. Soc Sci Med. 1996;43:933–945.
    1. Agyepong IA, Manderson L. The diagnosis and management of fever at household level in the Greater Accra Region, Ghana. Acta Trop. 1994;58:317–330.
    1. Onwujekwe O, Uzochukwu B, Eze S, Obikeze E, Okoli C, et al. Improving equity in malaria treatment: relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria. Malar J. 2008;7:5.
    1. Tagbor H, Cairns M, Nakwa E, Browne E, Sarkodie B, et al. The clinical impact of combining intermittent preventive treatment with home management of malaria in children aged below 5 years: cluster randomised trial. Trop Med Int Health. 2011;16:280–289.
    1. Ahorlu CK, Koram KA, Seakey AK, Weiss MG. Effectiveness of combined intermittent preventive treatment for children and timely home treatment for malaria control. Malar J. 2009;8:292.
    1. Ajayi IO, Browne EN, Garshong B, Bateganya F, Yusuf B, et al. Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites. Malar J. 2008;7:6.
    1. Kirkwood BR, Manu A, Tawiah-Agyemang C, ten Asbroek G, Gyan T, et al. NEWHINTS cluster randomised trial to evaluate the impact on neonatal mortality in rural Ghana of routine home visits to provide a package of essential newborn care interventions in the third trimester of pregnancy and the first week of life: trial protocol. Trials. 2010;11:58.
    1. Wiseman V, Kim M, Mutabingwa TK, Whitty CJ. Cost-effectiveness study of three antimalarial drug combinations in Tanzania. PLoS Med. 2006;3:e373.

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