Cost of community-led larval source management and house improvement for malaria control: a cost analysis within a cluster-randomized trial in a rural district in Malawi

Malaria Journal

Michèle van Vugt¹  Henk van den Berg²  Willem Takken²  Robert S. McCann³  Eve Worrall⁴  Mphatso Dennis Phiri⁵  Dianne J. Terlouw⁶  Alinune Nathanael Kabaghe⁷  Steven Gowelo⁷  Tumaini Malenga⁷  Kamija S. Phiri⁷  Tinashe Tizifa⁷ 

[1] Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam-UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands;Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands;Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands;School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi;Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA;Liverpool School of Tropical Medicine, Liverpool, UK;Malaria Epidemiology Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi;Malaria Epidemiology Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi;Liverpool School of Tropical Medicine, Liverpool, UK;School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi;

关键词: Malaria;    Cost analysis;    House improvement;    Larval source management;    Community-led;   

DOI  :  10.1186/s12936-021-03800-4

来源: Springer

【 摘 要 】

BackgroundHouse improvement (HI) to prevent mosquito house entry, and larval source management (LSM) targeting aquatic mosquito stages to prevent development into adult forms, are promising complementary interventions to current malaria vector control strategies. Lack of evidence on costs and cost-effectiveness of community-led implementation of HI and LSM has hindered wide-scale adoption. This study presents an incremental cost analysis of community-led implementation of HI and LSM, in a cluster-randomized, factorial design trial, in addition to standard national malaria control interventions in a rural area (25,000 people), in southern Malawi.MethodsIn the trial, LSM comprised draining, filling, and Bacillus thuringiensis israelensis-based larviciding, while house improvement (henceforth HI) involved closing of eaves and gaps on walls, screening windows/ventilation spaces with wire mesh, and doorway modifications. Communities implemented all interventions. Costs were estimated retrospectively using the ‘ingredients approach’, combining ‘bottom-up’ and ‘top-down approaches’, from the societal perspective. To estimate the cost of independently implementing each intervention arm, resources shared between trial arms (e.g. overheads) were allocated to each consuming arm using proxies developed based on share of resource input quantities consumed. Incremental implementation costs (in 2017 US$) are presented for HI-only, LSM-only and HI + LSM arms. In sensitivity analyses, the effect of varying costs of important inputs on estimated costs was explored.ResultsThe total economic programme costs of community-led HI and LSM implementation was $626,152. Incremental economic implementation costs of HI, LSM and HI + LSM were estimated as $27.04, $25.06 and $33.44, per person per year, respectively. Project staff, transport and labour costs, but not larvicide or screening material, were the major cost drivers across all interventions. Costs were sensitive to changes in staff costs and population covered.ConclusionsIn the trial, the incremental economic costs of community-led HI and LSM implementation were high compared to previous house improvement and LSM studies. Several factors, including intervention design, year-round LSM implementation and low human population density could explain the high costs. The factorial trial design necessitated use of proxies to allocate costs shared between trial arms, which limits generalizability where different designs are used. Nevertheless, costs may inform planners of similar intervention packages where cost-effectiveness is known.Trial registration Not applicable. The original trial was registered with The Pan African Clinical Trials Registry on 3 March 2016, trial number PACTR201604001501493

【 授权许可】

CC BY