The World Health Organisation (WHO) launched the Roll Back Malaria campaign in 1998. Its goal is a significant reduction in the malaria burden, particularly in Africa, where transmission rates are high. But what are the most cost-effective strategies to combat malaria? Researchers from the London School of Hygiene and Tropical Medicine address this question with an economic analysis of malaria control measures.

Malaria kills around one million children each year in sub-Saharan Africa and causes ill-health for many more. There are wide variations in transmission rates and patterns across the region: in some places transmission is low and seasonal or sporadic, in others transmission rates are high throughout the year.

This research aims to support the WHO initiative by reviewing existing literature and applying an economic analysis to evaluate malaria control measures. Using a modelling approach, researchers were able to apply results from country-specific studies to predict cost-effectiveness in other settings. The analysis focused on the prevention of malaria in childhood and pregnancy and improving the case management of uncomplicated malaria.

The analysis showed that:

• The use of insecticide-treated nets to prevent malaria in children is most cost-effective in poorer countries. It also becomes an attractive option in higher-income countries if nets are already in widespread use.
• Insecticide spraying of homes would be a cost-effective option for reducing infant mortality in poorer countries.
• Preventative drug treatment for children is a highly attractive strategy, although there are concerns about drug resistance, reduced levels of immunity and compliance.
• Preventative treatment with either chloroquine or sulfadoxine pyrimethamine (SP) during first pregnancies is highly cost-effective, even where drug resistance is high.
• Other cost-effective strategies include measures to increase patient compliance with medication and improved availability of alternative drug treatments in resistant cases.
• The impact of diagnostic tests on health outcomes is not clear. Their cost implications depend on the price of the first-line anti-malarial drug used. The use of microscopy and dipstick tests provides best value where first line drugs are expensive and current diagnostic methods are inaccurate.

Policy lessons arising from this study are:

• Measures to prevent malaria in childhood are highly cost-effective, but the financial costs of wide coverage are high and could increase health sector budgets by over 20 percent.
• It is unlikely that low-income countries could afford these costs, so donor funding is required.
• Intermittent drug treatment in pregnancy is very cost-effective and relatively affordable. However, costs will be higher if an antenatal care infrastructure is not in place.
• Measures to improve case management and drug availability require further study and involve a trade-off between providing prompt treatment and slowing the development of drug resistance.
• The level of existing healthcare infrastructure affects the incremental costs of malaria prevention measures.
• There is a need to build research capacity within Africa to study further the epidemiology of malaria and the economics of its control.

Source(s):
'Economic analysis of malaria control in sub-Saharan Africa' by C. Goodman, P. Coleman and A. Mills, Global Forum for Health Research, Geneva (2000)
'Cost-effectiveness of malaria control in sub-Saharan Africa' by C. Goodman, P. Coleman and A. Mills, The Lancet 354 (1999)
Related source: 'Review article: The evidence base on the cost-effectiveness of malaria control measures in Africa' by C. Goodman and A. Mills, Health Policy and Planning 14 (1999)

Funded by: Global Forum For Health Research; UK Department for International Development

id21 Research Highlight: 18 January 2002

Further Information:
Catherine Goodman
Health Policy Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0) 20 7927 2275
Fax: +44 (0) 20 7637 5391
Contact the contributor: catherine.goodman@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
Check the Roll Back Malaria site for the latest news and information on this WHO initiative.

The Malaria Foundation has information on many malaria-related issues, including research, plus a forum for discussion.

Look at the issue of International Health Matters on malaria.