title: Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana.
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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00119132.
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England. Edith.Patouillard@lshtm.ac.uk
authors.forename: Edith
authors.initials: E
authors.lastname: Patouillard
authors.forename: Lesong
authors.initials: L
authors.lastname: Conteh
authors.forename: Jayne
authors.initials: J
authors.lastname: Webster
authors.forename: Margaret
authors.initials: M
authors.lastname: Kweku
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
authors.forename: Brian
authors.initials: B
authors.lastname: Greenwood
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D005869:Ghana; D017048:Health Care Costs; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D010349:Patient Compliance; D011314:Preventive Health Services / Q000191:economics*
chemical_list: D000962:Antimalarials
references.citation: Malar J. 2008 Jan 08;7:5
references.pmid: 18182095
references.citation: PLoS One. 2010 Aug 17;5(8):e12223
references.pmid: 20808923
references.citation: Trials. 2010 May 17;11:58
references.pmid: 20478070
references.citation: Trop Med Int Health. 2006 Mar;11(3):299-313
references.pmid: 16553910
references.citation: Trop Med Int Health. 2011 Mar;16(3):280-9
references.pmid: 21159081
references.citation: BMC Public Health. 2011 Jul 18;11:573
references.pmid: 21767403
references.citation: PLoS Med. 2006 Oct;3(10):e373
references.pmid: 17032059
references.citation: Trop Med Int Health. 2007 Jun;12(6):743-50
references.pmid: 17550471
references.citation: Acta Trop. 1994 Dec;58(3-4):317-30
references.pmid: 7709870
references.citation: PLoS Med. 2007 Aug;4(8):e255
references.pmid: 17713981
references.citation: Soc Sci Med. 1987;25(3):293-305
references.pmid: 3629303
references.citation: Malar J. 2009 Dec 11;8:292
references.pmid: 20003357
references.citation: BMC Health Serv Res. 2008 Jul 31;8:165
references.pmid: 18671874
references.citation: Soc Sci Med. 1996 Sep;43(6):933-45
references.pmid: 8888463
references.citation: PLoS One. 2011 Feb 14;6(2):e16976
references.pmid: 21340029
references.citation: Malar J. 2008 Jan 08;7:6
references.pmid: 18182114
references.citation: Trop Med Int Health. 1999 Dec;4(12):836-45
references.pmid: 10632992
references.citation: PLoS Med. 2011 Feb 01;8(2):e1000409
references.pmid: 21304921
references.citation: PLoS One. 2009 Sep 30;4(9):e7256
references.pmid: 19789648