Monitoring, characterization and control of chronic, symptomatic malaria infections in rural Zambia through monthly household visits by paid community health workers

Hamainza, Busiku; Moonga, Hawela; Sikaala, Chadwick H; Kamuliwo, Mulakwa; Bennett, Adam; Eisele, Thomas P; Miller, John; Seyoum, Aklilu; Killeen, Gerry F

doi:10.1186/1475-2875-13-128

Table 3 Observed and potential cost-effectiveness of cases appropriately diagnosed and treated ^{vi vii vii ix}

From: Monitoring, characterization and control of chronic, symptomatic malaria infections in rural Zambia through monthly household visits by paid community health workers

	Health facility	Community based
Directly observed process indicators over 6 months		Passive	Active	Total
Covered community based cluster or facility catchment	77754	17543	17543	17543
Diagnostic tests carried out over six months	29897	2652	42556	45208
Diagnostically confirmed and treated cases of malaria infection over 6 months	15568	1260	10149	11409
Diagnostically confirmed and treated malaria case per head population over 6 months	0.20	0.07	0.58	0.65
Diagnostic tests per head of population over 6 months	0.38	0.15	2.43	2.58
Directly observed costs over 6 months
RDT tests conducted	29,376	2,652	42,556	45,208
Cost per test (US$)	0.31	0.31	0.31	0.31
Total RDT cost (US$)	9,113	823	13,201	14,024
Microscopy tests	521	n/a	n/a	n/a
Cost per test (US$)	1.30	n/a	n/a	n/a
Total cost of microscopy (US$)	676	n/a	n/a	n/a
AL treatments	21,827	1,279	10,684	11,963
Cost per treatment (US$)	1.38	1.38	1.38	1.38
Total cost of AL (US$)	30,069	1,762	14,718	16,480
Total personnel costs (US$)	281,150	18,001	18,001	18,001
Time commitment (% FTE)	30	10	90	100
Personnel costs of malaria testing and treatment	84,345	1,800	16,201	18,001
Sundry maintenance, transport and running costs for six months (US$)	43,201	103	926	1,029
Total cost for Six months (US$)	167,404	4,488	45,046	49,533
Total non-treatment costs over 6 months (US$)	137,335	2,726	30,328	33,053
Projected annual summaries at observed rates of testing & treatment
Total cost per head of population covered per year (US$)	4.31	0.51	5.14	5.65
Total non-treatment costs per head of population covered per year (US$)	3.53	0.31	3.46	3.77
Total cost per confirmed case treated (US$)	10.75	3.56	4.44	4.34
Projected potential summaries at optimized rates of active testing & treatment
Total cost per head of population covered per year (US$)			10.68
Total non-treatment costs per head of population covered per year (US$)			6.25
Total cost per confirmed case treated (US$)			8.09

^viUS$ 1 = ZMW 4.89, exchange rate has been rebased to fit current Zambian currency.
Source: http://www.boz.zm/(S(keg4bza3j0p4fx2uixtmnibq))/FinanciaMarkestReport.aspx. Accessed 1st October 2013.
^viiFTE - Full Time Equivalent.
^viiiIn the projected annual summaries, cost per head of population was calculated by dividing the total costs by the catchment population. The cost of non treatment is the cost of only testing such as in an elimination scenario. The cost per confirmed case if the total costs divided by the diagnostically confirmed and treated cases of malaria infection.
^ixProjected potential summaries developed from assumptions that the HF and CHW passive will not change even in an optimized environment. Cost/head of population calculated by addition to observed cost of an average 9 missed active visits per person and 2 passive visits per person by the cost of RDTs and Treatment respectively. The cost per confirmed case treated is the total cost per head divided by the mean number of CHW detected infections per year of 1.3.

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