Intermittent preventive treatment of malaria in pregnancy: the incremental cost-effectiveness of a new delivery system in Uganda.
The main objective of this study was to assess whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilisers could administer intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) to pregnant women. The study was implemented in 21 community clusters (intervention) and four clusters where health centres provided routine IPTp (control). The primary outcome measures were the proportion of women who completed two doses of SP; the effect on anaemia, parasitaemia and low birth weight; and the incremental cost-effectiveness of the intervention. The study enrolled 2785 pregnant women. The majority, 1404/2081 (67.5%) receiving community-based care, received SP early and adhered to the two recommended doses compared with 281/704 (39.9%) at health centres (P<0.001). In addition, women receiving community-based care had fewer episodes of anaemia or severe anaemia and fewer low birth weight babies. The cost per woman receiving the full course of IPTp was, however, higher when delivered via community care at US$2.60 compared with US$2.30 at health centres, due to the additional training costs. The incremental cost-effectiveness ratio of the community delivery system was Uganda shillings 1869 (US$1.10) per lost disability-adjusted life-year (DALY) averted. In conclusion, community-based delivery increased access and adherence to IPTp and was cost-effective.
Department of Community Health, Ministry of Health, Kampala, Uganda. vpadmn@infocom.co.ug
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Mbonye
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Hansen
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Bygbjerg
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Magnussen
D000293:Adolescent; D000740:Anemia / Q000188:drug therapy / Q000517:prevention & control; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage* / Q000191:economics; D003153:Community Health Services / Q000191:economics / Q000592:standards; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D016503:Drug Delivery Systems / Q000191:economics* / Q000592:standards; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D008288:Malaria / Q000188:drug therapy / Q000517:prevention & control*; D008430:Maternal-Child Health Centers / Q000191:economics / Q000592:standards; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000592:standards; D011739:Pyrimethamine / Q000008:administration & dosage* / Q000191:economics; D012307:Risk Factors; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000191:economics; D014454:Uganda
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine