Malaria is one of the leading causes of morbidity in endemic countries. Between 350 and  660 million  clinical  episodes of the disease occur per year among African children,  and roughly 1.2 million deaths (representing 2% of all premature deaths  in the world) are caused annually by malaria  in  low- and middle-income countries,  although estimates range from 700 000 to 2.7 million deaths per year. Of all global deaths, due to malaria, around 75% are estimated to occur in African children. Current WHO recommendations for malaria control in children in endemic areas rely on case management, use of insecticide-treated nets and vector control, none of which has proved fully efficacious for controlling the infection. Hence, there is a need to test new strategies that, combined with existing interventions, can effectively reduce the burden of malaria among children in endemic areas.

 Guy Hutton, David Schellenberg et al; 2009; 87:123–129 | doi:10.2471/BLT.08.051961 

For over a decade, malaria treatment in sub-Saharan Africa and other endemic regions has been in crisis. Conventional anti-malarial drugs such as chloroquine and sulphadoxine/pyrimethamine (SP) have become increasingly obsolete in the face of growing drug resistance. Current debates favour using artemisinin-based combination therapy (ACT) regimens. ACTs are highly efficacious and offer potential to check the progression of drug resistance. They are also expensive with prices as much as 10 to 20 times greater than conventional monotherapies. The development of anti-malarial drug resistance has led to increasing calls for the introduction of artemisinin-based combination therapy (ACT). However, little evidence is available on the full costs associated with changing national malaria treatment policy. This paper presents findings on the actual drug and a non-drug cost associated with deploying ACT in one district in Tanzania, and uses these data to estimate the nationwide costs of implementation in a setting where identification of malaria cases is primarily dependent on clinical diagnosis. Detailed data were collected over a three-year period on the financial costs of providing ACT in Rufiji District as part of a large-scale effectiveness evaluation, including costs of drugs, distribution, training, treatment guidelines and other information, education and communication (IEC) materials and publicity. The district-level costs were scaled up to estimate the costs of nationwide implementation, using four scenarios to extrapolate variable costs.

Joseph D Njau, Catherine A Goodman et al; 2008, 7:4 doi: 10.1186/1475-2875-7-4  

Despite continuing research on the epidemiology and control of malaria epidemics, little is known about the medical public health burden associated with these events. The data that are available indicate that epidemics can cause widespread morbidity and that epidemic-related risks of severe disease and death are relatively high across all age groups affected]. Moreover, little is known about the economic burden of epidemics, or the costs of interventions used for epidemic prevention and control. Without reliable information in this area policy makers are unable to make informed resource allocation decisions based on sound evidence. Malaria epidemics cause substantial morbidity and mortality in highland areas of Africa. The costs of detecting and controlling these epidemics have not been explored adequately in the past. This study presents the costs of establishing and running an early detection system (EDS) for epidemic malaria in four districts in the highlands of Kenya and Uganda. An economic costing was carried out from the health service provider's perspective in both countries. Staff time for data entry and processing, as well as supervising and coordinating EDS activities at district and national levels was recorded and associated opportunity costs estimated. A threshold analysis was carried out to determine the number of DALYs or deaths that would need to be averted in order for the EDS to be considered cost-effective.

 Dirk H Mueller, Tarekegn  Abeku 2009, 8:17 doi:10.1186/1475-2875-8-17

physician 'serif'; font-size: 12pt">In sub-Saharan Africa over 70% of patients with suspected malaria diagnose and manage their illness at home with traditional remedies or drugs bought from local shops. Attendance at a health clinic usually occurs only after home treatment has failed. Primary level health facilities lack tools for detection of malaria parasitaemia so a diagnosis of malaria is usually based on clinical symptoms such as fever. Despite the development of algorithms to improve the specificity of clinical malaria diagnosis, viagra many infectious diseases mimic malaria illness so this approach leads to over diagnosis rates of 30–70% depending on malaria transmission patterns. Over diagnosis of malaria leads to unnecessary anti malarial drug use, salve increased drug resistance, and delays in achieving the correct diagnosis: all of which prompt return visits to health facilities. It is estimated that over 70% of patients with suspected malaria in sub-Saharan Africa, diagnose and manage their illness at home without referral to a formal health clinic. Of those patients who do attend a formal health clinic, malaria over diagnosis rates are estimated to range between 30–70%. This paper details an observational cohort study documenting the number and cost of repeat consultations as a result of malaria over diagnosis at two health care providers in a rural district of Mozambique. 535 adults and children with a clinical diagnosis of malaria were enrolled and followed over a 21 day period to assess treatment regimen, symptoms, number and cost of repeat visits to health providers in patients misdiagnosed with malaria compared to those with confirmed malaria (determined by positive bloodfilm reading). Jen  Hum, Guy Barnish; 18 February 2008

The role of RDTs and decisions in their implementation In sub-Saharan Africa, management of febrile patients is typically characterized by over-prescription of anti-malarial drugs, as clinicians often do not have access to, or do not request, laboratory testing before prescribing anti malarials. Such practices were accepted, and even encouraged, when older, more affordable antimalarial such as chloroquine and sulphadoxine-pyrimethamine were effective. However, now that parasite resistance necessitates the introduction of new regimens such as artemisinin combination therapies (ACTs), the strategy of presumptive treatment has become more problematic, as the new drugs are significantly more expensive and their safety profiles are not fully characterized. Use of rapid diagnostic tests (RDTs) to guide anti malarial therapy is increasingly advocated as a potentially safe and cost-effective strategy for fever case management. Rapid diagnostic tests (RDTs) for malaria are increasingly being considered for routine use in Africa. However, many RDTs are available and selecting the ideal test for a particular setting is challenging. The appropriateness of RDT choice depends in part on patient population and epidemiological setting, and on decision makers' priorities. The model presented (available online) can be used by decision makers to evaluate alternative RDTs and assess the circumstances under which their use is justified on economic grounds.

Yoel Lubell, Heidi Hopkins et al; 2008, 7:21 doi: 10.1186/1475-2875-7-21