Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District.
OBJECTIVE
To assess the cost-effectiveness of two strategies of home management of under-five fevers in Ghana - treatment using antimalarials only (artesunate-amodiaquine - AAQ) and combined treatment using antimalarials and antibiotics (artesunate-amodiaquine plus amoxicillin - AAQ + AMX).


METHODS
We assessed the costs and cost-effectiveness of AAQ and AAQ + AMX compared with a control receiving standard care. Data were collected as part of a cluster randomised controlled trial with a step-wedged design. Approximately, 12,000 children aged 2-59 months in Dangme West District in southern Ghana were covered. Community health workers delivered the interventions. Costs were analysed from societal perspective, using anaemia cases averted, under-five deaths averted and disability-adjusted life years (DALYs) averted as effectiveness measures.


RESULTS
Total economic costs for the interventions were US$ 204,394.72 (AAQ) and US$ 260,931.49 (AAQ + AMX). Recurrent costs constituted 89% and 90% of the total direct costs of AAQ and AAQ + AMX, respectively. Deaths averted were 79.1 (AAQ) and 79.9 (AAQ + AMX), with DALYs averted being 2264.79 (AAQ) and 2284.57 (AAQ + AMX). The results show that cost per anaemia case averted were US$ 150.18 (AAQ) and US$ 227.49 (AAQ + AMX) and cost per death averted was US$ 2585.58 for AAQ and US$ 3272.20 for AAQ + AMX. Cost per DALY averted were US$ 90.25 (AAQ) and US$ 114.21 (AAQ + AMX).


CONCLUSIONS
Both AAQ and AAQ + AMX approaches were cost-effective, each averting one DALY at less than the standard US$ 150 threshold recommended by the World Health Organisation. However, AAQ was more cost-effective. Home management of under-five fevers in rural settings is cost-effective in reducing under-five mortality.
School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
Justice
J
Nonvignon
Margaret A
MA
Chinbuah
Margaret
M
Gyapong
Mercy
M
Abbey
Elizabeth
E
Awini
John O
JO
Gyapong
Moses
M
Aikins
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D000962:Antimalarials / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D002675:Child, Preschool; D003150:Community Health Workers / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D005260:Female; D005334:Fever / Q000188:drug therapy*; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D012424:Rural Population; D012648:Self Care / Q000191:economics*
D000900:Anti-Bacterial Agents; D000962:Antimalarials