Prevention, Management and Cost Implications of Malaria in Niger Delta, Southern Nigeria
Keywords:
malaria, medical expenditure, cost of illness, cost of therapyAbstract
Background: An estimated 97.0% of Nigeria’s population is reported to be at risk of malaria with about 100 million cases and over 300,000 deaths per year. The study evaluated malaria preventive strategies, its treatment as well as cost implications.
Methods: The descriptive cross sectional study was conducted in Yenagoa and Amassoma which are the two most populous towns in Bayelsa State, south-south Nigeria. A self-developed and validated questionnaire on malaria, preventive strategies, and treatment among others was administered to Five hundred and Seventy Four respondents. Information collected and analysed from the questionnaire include occurrence of malaria attack, method of diagnosis, malaria treatment modes, types of medications used, duration of treatment, forms of malaria prevention and cost implications of medication/therapy.
Results: There is high prevalence of malaria among the populace and poor attitude towards prevention in about 40.0% of the respondents. Less than 40.0% of the 123 pregnant subjects had intermittent preventive therapy for malaria using sulphadoxine-pyrimethamine tablet as recommended by World Health Organization for Africa. There was irrational drug therapy in 79.6% of the subjects with wide use of mono-therapy and the use of arthemeter/lumefantrine in only 123 (21.4%). Most of the respondents reported direct out of pocket payment for the recommended anti-malaria remedies. An average of NGN438.75±133.17 (USD2.74±0.83) was spent per subject on antimalarial drugs while the mean treatment cost per patient which represents the total amount claimed to have been spent by respondents for drugs, and consultations in some cases was NGN566.56 (USD3.54). The national cost implication is in excess of about NGN50 billion (USD312 million) for antimalarial drug alone even with wide use of sub optimal mono-therapy.
Conclusion: Prevalence of malaria is very high in the locality and modes of prevention and treatment are suboptimal. Also, Intermittent Preventive Treatment culture among the pregnant women is not encouraging hence, the need to create awareness geared towards improving health seeking behaviours among this special population. The cost implications of malaria therapy are huge and concerted efforts from stakeholders are necessary to reduce incidences thereby minimizing the cost.
References
[UNICEF] United Nations Children’s Fund. (2000). Malaria prevention and treatment. The Prescriber. 18: 1-16. Available from http://www.unicef.org/prescriber/eng_p18.pdf (Accessed May 30th, 2015).
[WHO] World Health Organization. Water-related Diseases: Malaria. WHO (2001). Available at http://www.who.int/water_sanitation_health/diseases/malaria/en/ (Accessed May 30th, 2013).
Schantz-Dunn J, Nour NM. (2009). Malaria and Pregnancy: A Global Health Perspective. Rev Obstet Gynecol. 2(3):186-192.
Olasehinde GI, Ajayi AA, Taiwo SO, Adekeye BT, Adeyeba OA. (2010). Prevalence and management of falciparium malaria among infants and children in Ota, Ogun State, Southwestern Nigeria. Afr J Cln. Exper Microbiol. 11(3): 159-163
[USAID/PMI] USAID/United State President Malaria Initiatives. (2011). Nigeria Malaria Fact Sheet. Economic Section, United States Embassy in Nigeria Plot 1075, Diplomatic Drive Central Area Abuja, FCT, Nigeria 2011 4000; Available from: http://nigeria.usembassy.gov. Accessed 10th June, 2015.
Madukosiri CH Bawo DS (2012) llness pattern and the relationship between the prevalence of malaria and other infections in Niger Delta University. Agric. Biol. J. N. Am., 2012, 3(10): 413-426.
[WHO] World Health Organization (2002). Implementation of the global malaria control strategy. Reports of the World Health Organization Study Group on The Implementation the Global Plan of Action for malaria control 1993 – 2002. WHO Technical Report Series 839, WHO, Geneva.
[WHO] World Health Organization. (2005).. World Malaria Report 2005. Available http://www.rbm.who.int/wmr2005/pdf/adv_e.pdf (Accessed May 31st, 2015).
Das LK, Jambulingam P, Sadanandane C. (2008). Impact of community-based presumptive chloroquine treatment of fever cases on malaria morbidity and mortality in a tribal area in Orissa State, India.. Malar J 7:75
[WHO] World Health Organization. (2013). WHO_ Factsheet on the World Malaria Report 2013.html World Health Organisation Geneva Available from: www.who.int/malaria/media/world_malaria_report_2013/en (Accessed May 2015).
[WHO/RBM] World Health Organization/Roll Back Malaria (2005). Global Strategic Plan/Roll Back Malaria 2005-2015. WHO/RBM Patnership 2005. Available from http://www.rbm.who.int/forumV/docs/gsp_en.pdf (Accessed May 31st, 2015).
Mbonye AK, Neema S, Magnussen P (2006). Preventing malaria in pregnancy: a study of perceptions and policy implications in Mukono district, Uganda. Health Policy Plan 2006; 21 (1): 17-26
[WHO] World Health Organization Global Malaria Programme. (2012). “Intermittent Preventive Treatment of Malaria in Pregnancy Using Sulfadoxine-Pyrimethamine (IPTp-SP).” World Health Organization. Available from: http://who.int/malaria/iptp_sp_updated_policy_recommendation_en_102012.pdf?ua=1 (Accessed April 2014)
Bausell L, Katherine W. (2014). Treatment Uptake and Availability of Antimalarial Drugs for Intermittent Preventative Treatment in Pregnant Women in Malawi. Arlington, Va.: USAID | DELIVER PROJECT, Task Order 7
Falade CO Nash O Akingbola TS Michael OS Olojede F Ademowo OG. (2009). Blood banking in a malaria-endemic area: evaluating the problem posed by malarial parasitaemias. Ann Trop Med Parasitol. 103(5):383-92
[LASG/MOH] Lagos State Ministry of Health. Malaria Control Program. Lagos State Ministry of Health, (2013). Available from http://www.lagosstateministryofhealth.com/programme_info.php?programme_id=6 (Accessed May 30th, 2015)
[WHO] World Health Organization. (2010). Malaria Funding & Resource Utilization: The First Decade of Roll Back Malaria. Roll Back Malaria Progress & Impact Series Number 1 March 2010. World Health Organisation. Available at http://www.rbm.who.int/ProgressImpactSeries/docs/RBMMalariaFinancingReport-en.pdf (Accessed May 31st, 2015).
Ndo C, Menze-Djantio B, Antonio-Nkondjio C. (2011). Awareness, attitudes and prevention of malaria in the cities of Douala and Yaoundé (Cameroon). Parasites & Vectors. 4:181
WHO (2012). Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva, World Health Organization, 2012.
http://www.who.int/nutrition/publications/micronutrients/guidelines/daily_ifa_supp_pregnant_women/en/index.html (Accessed Aug 20th, 2015).
[{WHO] World Health Organization (2013). Policy Brief for the Implementation of Intermittent Preventive Treatment of Malaria in Pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) 11 April 2013.World Health Organization. Geneva.
Tatfeng Y M. (2011). The Attitude of Patients towards the Treatment of Malaria in Edo State, Nigeria. East and Cent Afr J of Pharm Sci. 14: 95-97
Bloland PB, Ettling M, Meek. (2000). Combination therapy for malaria in Africa: hype or hope? Bull World Health Organ. 78: 1378–1388
Murray CK, Gasser Jr RA, Magill AJ, Miller RS (2008). Update on Rapid Diagnostic Testing for Malaria. Clin Microbiol Rev; 21(1): 97-110
Okenu DMN. (1999). An Integrated Approach for Malaria Control in Africa. Malar and Infect Dis in Afr. 10: 4-13
Rusk A, Goodman C, Naanyu V, Koech B, Obala A, O’Meara WP (2013). Expanding Access to Malaria Diagnosis through Retail Shops in Western Kenya: What Do Shop Workers Think? Malaria Research and Treatment 2013, Article ID 398143, 9 pages Available from http://www.hindawi.com/journals/mrt/2013/398143/ (Accessed June 3rd, 2013)
[WHO] World Health Organization (2011). Chapter six: Diagnostic testing and treatment of malaria. World Malaria report 2011. Available at http://www.who.int/malaria/world_malaria_report_2011/WMR2011_chapter6.pdf (Accessed May 31st, 2015)
Shillcutt S, Morel C, Goodman C, Coleman P, Bell D, Whitty C J M, Mills A. (2008). Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy. Bull World Health Organ. 86 (2): 101-10
