Cost effectiveness of OptiMal® rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil.

BACKGROUND: In areas with limited structure in place for microscopy diagnosis, rapid diagnostic tests (RDT) have been demonstrated to be effective. METHOD: The cost-effectiveness of the Optimal® and thick smear microscopy was estimated and compared. Data were collected on remote areas of 12 municipalities in the Brazilian Amazon. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, hospitalization records, primary data collected from the municipalities, and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2006. The results were expressed in costs per adequately diagnosed cases in 2006 U.S. dollars. Sensitivity analysis was performed considering key model parameters. RESULTS: In the case base scenario, considering 92% and 95% sensitivity for thick smear microscopy to Plasmodium falciparum and Plasmodium vivax, respectively, and 100% specificity for both species, thick smear microscopy is more costly and more effective, with an incremental cost estimated at US$549.9 per adequately diagnosed case. In sensitivity analysis, when sensitivity and specificity of microscopy for P. vivax were 0.90 and 0.98, respectively, and when its sensitivity for P. falciparum was 0.83, the RDT was more cost-effective than microscopy. CONCLUSION: Microscopy is more cost-effective than OptiMal® in these remote areas if high accuracy of microscopy is maintained in the field. Decision regarding use of rapid tests for diagnosis of malaria in these areas depends on current microscopy accuracy in the field.

The process of changing national malaria treatment policy: lessons from country-level studies.

Widespread resistance of Plasmodium falciparum parasites to commonly used antimalarials, such as chloroquine, has resulted in many endemic countries considering changing their malaria treatment policy. Identifying and understanding the key influences that affect decision-making, and factors that facilitate or undermine policy implementation, is critical for improving the policy process and guiding resource allocation during this process. A historical review of archival documents from Malawi and data obtained from in-depth policy studies in four countries (Tanzania, South Africa, Kenya and Peru) that have changed malaria treatment policy provides important lessons about decision-making, the policy cycle and complex policy environment, while specifically identifying strategies successfully employed to facilitate policy-making and implementation. Findings from these country-level studies indicate that the process of malaria drug policy review should be institutionalized in endemic countries and based on systematically collected data. Key stakeholders need to be identified early and engaged in the process, while improved communication is needed on all levels. Although malaria drug policy change is often perceived to be a daunting task, using these and other proven strategies should assist endemic countries to tackle this challenge in a systematic fashion that ensures the development and implementation of the rational malaria drug policy.

Determining malaria effects in rural Colombia.

Good health is an integral component of the quality of human life, a prerequisite for developing human potential and an important determinant of economic development. When a person is ill from a tropical disease in an agricultural economy, a complex interaction between the individual's welfare and the family's welfare is set in motion. So complex are these interactions that few empirical studies exist on this subject and even where they do, empirical quantification of these interactions and economic losses places the analyst in the minefield of valuing time, ability and contribution to economic welfare. Placing monetary values on these commodities is always a little unsatisfactory since dollar values do not adequately reflect the nature of the losses. Secondly, the ill person's struggle to minimize the economic effects of disease on family income will mask its true impact; thirdly, tropical diseases disproportionately affect low-income groups and therefore measuring the income effects of disease amongst these groups will only reach at the earnings effect, and underestimate the economic implications of tropical disease control. Despite these difficulties, quantification of the economic impact of disease is important from a public health point of view. This study is an attempt at such a task, and focuses on the intra-familial struggle to minimize economic losses due to malaria. Using a case-control approach, time-losses and labour reallocations within the household are examined in an attempt to understand the economic consequences of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Human mobility and malaria risk in the Naya river basin of Colombia.

This paper develops and tests a methodology for examining the manner and the extent to which human mobility can be associated with malaria risk within an endemic area. The paper presents entomological, epidemiological and mobility results obtained from macro data and micro data. Results indicate that malaria is concentrated in the delta zone of the Naya river basin where the circulation of people into this zone for economic reasons occurs at a time when vector densities are high. High human density combined with high vector density ensures continuous and intense transmission of malaria. In attempting to measure intensity of transmission, microscopic analysis of parasitaemia was found to underestimate prevalence showing it to be very low or negligible, whereas serological data collected during the same period of time reveal that prevalence is high, and similar for both sexes. Serological data also indicate that prevalence increases with age particularly from adolescence onwards. Since mobility for agricultural purposes involves able-bodied males and females, there seems ample justification for concluding that human mobility into certain areas increases the risk of infection for adults, particularly when such mobility coincides with peak rainfall and vector densities. Micro-level data are critical in pinpointing causation and small area variations in risk. Thus the beach area is a high risk area within the delta region, particularly for adults, and this is likely to be because of high vector biting rates in the beach environment. One conclusion is that micro analysis of behaviour, when linked to epidemiological data are particularly useful in defining and locating areas and groups at highest risk; using such information to achieve intensive coverage on a small scale may be more cost-effective than attempting to achieve vector or chemotherapeutic control over a wider area for all groups.