title: Relative costs and effectiveness of treating uncomplicated malaria in two rural districts in Zambia: implications for nationwide scale-up of home-based management.
abstract: BACKGROUND
  Malaria case management is one of the key strategies to control malaria. Various studies have demonstrated the feasibility of home management of malaria (HMM). However, data on the costs and effectiveness of artemisinin-based combination therapy (ACT) and rapid diagnostic tests via HMM is limited.
  
  
  METHODS
  Cost-effectiveness of home management versus health facility-based management of uncomplicated malaria in two rural districts in Zambia was analysed from a providers' perspective. The sample included 16 community health workers (CHWs) and 15 health facilities. The outcome measure was the cost per case appropriately diagnosed and treated. Costs of scaling-up HMM nationwide were estimated based on the CHW utilisation rates observed in the study.
  
  
  RESULTS
  HMM was more cost effective than facility-based management of uncomplicated malaria. The cost per case correctly diagnosed and treated was USD 4.22 for HMM and USD 6.12 for facility level. Utilization and adherence to diagnostic and treatment guidelines was higher in HMM than at a health facility.
  
  
  CONCLUSIONS
  HMM using ACT and RDTs was more efficient at appropriately diagnosing and treating malaria than the health facility level. Scaling up this intervention requires significant investments.
authors.affiliation: Department of Public Health and Research, Ministry of Health Headquarters, Lusaka, Zambia. pascychanda@yahoo.com
authors.forename: Pascalina
authors.initials: P
authors.lastname: Chanda
authors.forename: Busiku
authors.initials: B
authors.lastname: Hamainza
authors.forename: Hawela B
authors.initials: HB
authors.lastname: Moonga
authors.forename: Victor
authors.initials: V
authors.lastname: Chalwe
authors.forename: Patrick
authors.initials: P
authors.lastname: Banda
authors.forename: Franco
authors.initials: F
authors.lastname: Pagnoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000008:administration & dosage* / Q000191:economics; D037621:Artemisinins / Q000008:administration & dosage* / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007783:Lactones / Q000008:administration & dosage* / Q000191:economics; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D016896:Treatment Outcome; D055815:Young Adult; D015024:Zambia
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D007783:Lactones; C075875:artemisin