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Cirera L, Sacoor C, Meremikwu M, Ranaivo L, F. Manun’Ebo M, Arikpo D, Matavele O, Rafaralahy V, Ndombe D, Pons Duran C, Ramirez M, Ramponi F, González R, Maly C, Roman E, Sicuri E, Pagnoni F, Menéndez C. The economic costs of malaria in pregnancy: evidence from four sub-Saharan countries. Gates Open Res 2023; 7:47. [PMID: 37234473 PMCID: PMC10205974 DOI: 10.12688/gatesopenres.14375.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 07/23/2023] Open
Abstract
Background Malaria in pregnancy is a major public health problem in sub-Saharan Africa (SSA), which imposes a significant economic burden. We provide evidence on the costs of malaria care in pregnancy to households and the health system in four high-burden countries in SSA. Methods Household and health system economic costs associated with malaria control in pregnancy were estimated in selected areas of the Democratic Republic of Congo (DRC), Madagascar (MDG), Mozambique (MOZ) and Nigeria (NGA). An exit survey was administered to 2,031 pregnant women when leaving the antenatal care (ANC) clinic from October 2020 to June 2021. Women reported the direct and indirect costs associated to malaria prevention and treatment in pregnancy. To estimate health system costs, we interviewed health workers from 133 randomly selected health facilities. Costs were estimated using an ingredients-based approach. Results Average household costs of malaria prevention per pregnancy were USD6.33 in DRC, USD10.06 in MDG, USD15.03 in MOZ and USD13.33 in NGA. Household costs of treating an episode of uncomplicated/complicated malaria were USD22.78/USD46 in DRC, USD16.65/USD35.65 in MDG, USD30.54/USD61.25 in MOZ and USD18.92/USD44.71 in NGA, respectively. Average health system costs of malaria prevention per pregnancy were USD10.74 in DRC, USD16.95 in MDG, USD11.17 in MOZ and USD15.64 in NGA. Health system costs associated with treating an episode of uncomplicated/complicated malaria were USD4.69/USD101.41 in DRC, USD3.61/USD63.33 in MDG, USD4.68/USD83.70 in MOZ and USD4.09/USD92.64 in NGA. These estimates resulted in societal costs of malaria prevention and treatment per pregnancy of USD31.72 in DRC, USD29.77 in MDG, USD31.98 in MOZ and USD46.16 in NGA. Conclusions Malaria in pregnancy imposes a high economic burden on households and the health system. Findings emphasize the importance of investing in effective strategies that improve access to malaria control and reduce the burden of the infection in pregnancy.
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Affiliation(s)
- Laia Cirera
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | | | - Martin Meremikwu
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Louise Ranaivo
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | - Manu F. Manun’Ebo
- Bureau d’Étude et de Gestion de l’Information Statistique (BEGIS), Kinshasa, Democratic Republic of the Congo
| | - Dachi Arikpo
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Victor Rafaralahy
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | - Didier Ndombe
- Bureau d’Étude et de Gestion de l’Information Statistique (BEGIS), Kinshasa, Democratic Republic of the Congo
| | - Clara Pons Duran
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Maximo Ramirez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | | | - Raquel González
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Christina Maly
- Jhpiego, a Johns Hopkins University affiliate, Baltimore, USA
| | - Elaine Roman
- Jhpiego, a Johns Hopkins University affiliate, Baltimore, USA
| | - Elisa Sicuri
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- London School of Economics and Political Science, London, UK
| | - Franco Pagnoni
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Clara Menéndez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Cirera L, Sacoor C, Meremikwu M, Ranaivo L, F. Manun’Ebo M, Arikpo D, Matavele O, Rafaralahy V, Ndombe D, Pons Duran C, Ramirez M, Ramponi F, González R, Maly C, Roman E, Sicuri E, Pagnoni F, Menéndez C. The economic costs of malaria in pregnancy: evidence from four sub-Saharan countries. Gates Open Res 2023; 7:47. [PMID: 37234473 PMCID: PMC10205974 DOI: 10.12688/gatesopenres.14375.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Background Malaria in pregnancy is a major public health problem in sub-Saharan Africa (SSA), which imposes a significant economic burden. We provide evidence on the costs of malaria care in pregnancy to households and the health system in four high-burden countries in SSA. Methods Household and health system economic costs associated with malaria control in pregnancy were estimated in selected areas of the Democratic Republic of Congo (DRC), Madagascar (MDG), Mozambique (MOZ) and Nigeria (NGA). An exit survey was administered to 2,031 pregnant women when leaving the antenatal care (ANC) clinic from October 2020 to June 2021. Women reported the direct and indirect costs associated to malaria prevention and treatment in pregnancy. To estimate health system costs, we interviewed health workers from 133 randomly selected health facilities. Costs were estimated using an ingredients-based approach. Results Average household costs of malaria prevention per pregnancy were USD6.33 in DRC, USD10.06 in MDG, USD15.03 in MOZ and USD13.33 in NGA. Household costs of treating an episode of uncomplicated/complicated malaria were USD22.78/USD46 in DRC, USD16.65/USD35.65 in MDG, USD30.54/USD61.25 in MOZ and USD18.92/USD44.71 in NGA, respectively. Average health system costs of malaria prevention per pregnancy were USD10.74 in DRC, USD16.95 in MDG, USD11.17 in MOZ and USD15.64 in NGA. Health system costs associated with treating an episode of uncomplicated/complicated malaria were USD4.69/USD101.41 in DRC, USD3.61/USD63.33 in MDG, USD4.68/USD83.70 in MOZ and USD4.09/USD92.64 in NGA. These estimates resulted in societal costs of malaria prevention and treatment per pregnancy of USD31.72 in DRC, USD29.77 in MDG, USD31.98 in MOZ and USD46.16 in NGA. Conclusions Malaria in pregnancy imposes a high economic burden on households and the health system. Findings emphasize the importance of investing in effective strategies that improve access to malaria control and reduce the burden of the infection in pregnancy.
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Affiliation(s)
- Laia Cirera
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | | | - Martin Meremikwu
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Louise Ranaivo
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | - Manu F. Manun’Ebo
- Bureau d’Étude et de Gestion de l’Information Statistique (BEGIS), Kinshasa, Democratic Republic of the Congo
| | - Dachi Arikpo
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Victor Rafaralahy
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | - Didier Ndombe
- Bureau d’Étude et de Gestion de l’Information Statistique (BEGIS), Kinshasa, Democratic Republic of the Congo
| | - Clara Pons Duran
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Maximo Ramirez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | | | - Raquel González
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Christina Maly
- Jhpiego, a Johns Hopkins University affiliate, Baltimore, USA
| | - Elaine Roman
- Jhpiego, a Johns Hopkins University affiliate, Baltimore, USA
| | - Elisa Sicuri
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- London School of Economics and Political Science, London, UK
| | - Franco Pagnoni
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Clara Menéndez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Mkubwa B, Kagura J, Chirwa T, Ibisomi L, Kinyanjui S. Determinants of utilization of malaria preventive measures during pregnancy among women aged 15 to 49 years in Kenya: an analysis of the Malaria Indicator Survey 2020. Malar J 2022; 21:398. [PMID: 36581863 PMCID: PMC9798621 DOI: 10.1186/s12936-022-04425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Malaria is a significant cause of morbidity and mortality. Malaria infection in pregnancy can have severe consequences for the fetus and the mother. To fight against malaria infection in pregnancy, Kenya integrated the issuance of an insecticide-treated net (ITN) and intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTpSP) with antenatal care (ANC) for pregnant women. However, the uptake of the ITN and IPTpSP is still low. Individual, social, or structural factors may influence the low uptake. It is, therefore, important to identify the determinants associated with the uptake of ITN and IPTpSP during pregnancy in Kenya. METHODS Data were from the 2020 Kenya Malaria Indicator Survey (MIS). A total of 1779 women between the ages of 15 to 49 years who had a history of either being pregnant or having given birth within 5 years before the MIS survey were included. Survey-adjusted multinomial logistic regression was used in the analysis. RESULTS During pregnancy, ITN use was more than half (54.9%). The use of at least one dose of IPTpSP was 43.5%, three or more doses of IPTpSP was 27.2%, and only 28.2% of the participants used both ITN and IPTpSP during pregnancy. The significant determinants of combined use of ITN and IPTpSP during pregnancy were maternal age (RR 3.57, CI 1.80-7.08; p=<0.001), maternal education (RRR 2.84, CI 1.33-6.06; p=0.007), wealth index (RR 2.14, CI 1.19-3.84; p=0.011) and living in the different malaria epidemiological zones: lake endemic (RRR 10.57 CI 5.65-19.76; p=<0.001), coastal endemic area (RRR 4.86 CI 1.86-12.67; p=0.001), seasonal (RRR 0.21 CI 0.10-0.39; p=<0.001) and low risk (RRR 0.07, CI 0.03-0.17; p=<0.001). CONCLUSION The uptake of malaria preventive measures is still below 80% for both ITN and IPTpSP during pregnancy in Kenya. The significant results on determinants of the use of ITN and IPTpSP could be considered in implementing malaria prevention programmes during pregnancy. For example, sensitizing the community on the importance of antenatal care visits will provide a platform to teach the importance of malaria prevention in pregnancy. Moreover, the pregnant mothers receive an ITN and IPTpSP during the ANC visit.
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Affiliation(s)
- Beatrice Mkubwa
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa
| | - Latifat Ibisomi
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa ,grid.416197.c0000 0001 0247 1197Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Samson Kinyanjui
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research (Coast), KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
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Alibhai KM, Ziegler BR, Meddings L, Batung E, Luginaah I. Factors impacting antenatal care utilization: a systematic review of 37 fragile and conflict-affected situations. Confl Health 2022; 16:33. [PMID: 35690840 PMCID: PMC9188725 DOI: 10.1186/s13031-022-00459-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is estimated that over 930 million people live in fragile and conflict-affected situations (FCAS) worldwide. These regions, characterized by violence, civil unrest, and war, are often governed by corrupt administrations who are unwilling to provide their citizens with basic human rights. Individuals living in FCAS face health inequities; however, women are disproportionally affected and face additional barriers to accessing sexual and reproductive services, including antenatal care (ANC). This systematic review aims to identify the factors that impact ANC usage in the 37 countries or regions classified as FCAS in 2020 by The World Bank. METHODS Using the PRISMA guidelines, a systematic search of five databases (SCOPUS, Web of Science, PubMed, EMBASE, and CINAHL) was conducted. Results were limited to human studies, written in English, and published between January 2002 and January 2022. Studies that identified factors affecting utilization of ANC or maternal health services were included for review and critically appraised using the National Institute of Health's Quality Assessment Tools. Findings were summarized using a narrative synthesis approach. RESULTS The database search yielded 26,527 studies. After title, abstract and full-text review, and exclusion of duplicate articles, 121 studies remained. Twenty-eight of the 37 FCAS were represented in the included studies. The studies highlighted that women in FCAS' are still not meeting the World Health Organization's 2002 recommendation of four ANC visits during pregnancy, a recommendation which has since been increased to eight visits. The most cited factors impacting ANC were socioeconomic status, education, and poor quality of ANC. Despite all studies being conducted in conflict-affected regions, only nine studies explicitly identified conflict as a direct barrier to accessing ANC. CONCLUSION This review demonstrated that there is a paucity in the literature examining the direct and indirect impacts of conflict on ANC utilization. Specifically, research should be conducted in the nine FCAS that are not currently represented in the literature. To mitigate the barriers that prevent utilization of maternal health services identified in this review, policy makers, women utilizing ANC, and global organizations should attempt to collaborate to enact policy change at the local level.
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Affiliation(s)
| | - Bianca R Ziegler
- DeGroote School of Medicine, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
| | - Louise Meddings
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Evans Batung
- Department of Geography, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
- Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
- Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
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