The economic costs of malaria in pregnancy: evidence from four sub-Saharan countries

Laia Cirera; Charfudin Sacoor; Martin Meremikwu; Louise Ranaivo; Manu F Manun'Ebo; Dachi Arikpo; Osvaldo Matavele; Victor Rafaralahy; Didier Ndombe; Clara Pons Duran; Maximo Ramirez; Francesco Ramponi; Raquel González; Christina Maly; Elaine Roman; Elisa Sicuri; Franco Pagnoni; Clara Menéndez

doi:10.12688/gatesopenres.14375.2

The economic costs of malaria in pregnancy: evidence from four sub-Saharan countries

Gates Open Res. 2023 May 5:7:47. doi: 10.12688/gatesopenres.14375.2. eCollection 2023.

Authors

Laia Cirera^#¹, Charfudin Sacoor^#², Martin Meremikwu^#³, Louise Ranaivo^#⁴, Manu F Manun'Ebo^#⁵, Dachi Arikpo^{3

6}, Osvaldo Matavele², Victor Rafaralahy⁴, Didier Ndombe⁵, Clara Pons Duran¹, Maximo Ramirez¹, Francesco Ramponi¹, Raquel González^{1

2

7}, Christina Maly⁸, Elaine Roman⁸, Elisa Sicuri^{1

9}, Franco Pagnoni¹, Clara Menéndez^{1

2

7}

Affiliations

¹ Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
² Manhiça Health Research Center, Manhiça, Mozambique.
³ Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria.
⁴ Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar.
⁵ Bureau d'Étude et de Gestion de l'Information Statistique (BEGIS), Kinshasa, Democratic Republic of the Congo.
⁶ Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.
⁷ CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
⁸ Jhpiego, a Johns Hopkins University affiliate, Baltimore, USA.
⁹ London School of Economics and Political Science, London, UK.

^# Contributed equally.

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.

Keywords: malaria in pregnancy; economic burden malaria; household costs; health system costs.

Associated data

figshare/10.6084/m9.figshare.21997595.v1

Grants and funding

The project was born and was designed after MiPPCOD (Title: Identifying new delivery approaches to maximize the coverage of malaria preventive interventions in pregnancy: Planning phase) [OPP1122709], a pilot research project financed by the Bill and Melinda Gates Foundation. The implementation of this project was also supported by: UNITAID [2017–13-TIPTOP] through a sub-award signed with Jhpiego [17-SBA-101]; the Spanish Ministry of Science and Innovation through the ‘Centro de Excelencia Severo Ochoa 2019–2023’ Program [CEX2018-000806-S] and the Generalitat de Catalunya through the CERCA Program.