Limits...
Household cost of malaria overdiagnosis in rural Mozambique.

Hume JC, Barnish G, Mangal T, Armázio L, Streat E, Bates I - Malar. J. (2008)

Bottom Line: Diagnosis based solely on clinical symptoms overdiagnosed 23% of children (<16y) and 31% of adults with malaria.Symptoms persisted (p = 0.023) and new ones developed (p < 0.001) in more adults than children in the three weeks following initial presentation.Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources.

View Article: PubMed Central - HTML - PubMed

Affiliation: Disease Control Strategy Group, Liverpool School of Tropical Medicine, Liverpool, UK. humej@niaid.nih.gov

ABSTRACT

Background: 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 overdiagnosis rates are estimated to range between 30-70%.

Methods: This paper details an observational cohort study documenting the number and cost of repeat consultations as a result of malaria overdiagnosis 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).

Results: Diagnosis based solely on clinical symptoms overdiagnosed 23% of children (<16y) and 31% of adults with malaria. Symptoms persisted (p = 0.023) and new ones developed (p < 0.001) in more adults than children in the three weeks following initial presentation. Adults overdiagnosed with malaria had more repeat visits (67% v 46%, p = 0.01-0.06) compared to those with true malaria. There was no difference in costs between patients correctly or incorrectly diagnosed with malaria. Median costs over three weeks were $0.28 for those who had one visit and $0.76 for > or = 3 visits and were proportionally highest among the poorest (p < 0.001)

Conclusion: Overdiagnosis of malaria results in a greater number of healthcare visits and associated cost for adult patients. Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources. Thus, investment in accurate malaria diagnosis and appropriate management at primary level is critical for improving health outcomes and reducing poverty.

Show MeSH

Related in: MedlinePlus

Adult and child health costs as % of monthly expenditure (US $) (filled circles = adult; unfilled circles = child).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2279141&req=5

Figure 2: Adult and child health costs as % of monthly expenditure (US $) (filled circles = adult; unfilled circles = child).

Mentions: Monthly household expenditure varied widely from $9–174 and did not differ significantly between those attending the private and government clinics (p = 0.826, Mann-Whitney U test). Median monthly expenditure was lowest in the households of children presenting to the private clinic (US$36.96) and highest in the households of adults presenting at the private clinics (US$41.3). Health costs over the 21 day study period ranged from $0.1–19.3 (median 1.1) and were proportionally significantly higher (p < 0.001, Mann-Whitney U test) in patients with a household expenditure of ≤ $40/month (i.e. the lowest quintile of household expenditure) compared to those with household expenditure $40–200 (Figure 2). Matching data about loss of earnings (i.e. indirect costs) and monthly expenditure was available for 20 adults and 38 carers. The amount of earnings lost through ill health or by having to take time off work to look after a sick family member varied widely from <$0.01 – $21.7. The median proportion of monthly expenditure that these lost earnings represented was 2.1% for those with expenditures <$40/month and 1.3% for those with expenditure >$40/month (p = 0.229, Mann-Whitney U test).


Household cost of malaria overdiagnosis in rural Mozambique.

Hume JC, Barnish G, Mangal T, Armázio L, Streat E, Bates I - Malar. J. (2008)

Adult and child health costs as % of monthly expenditure (US $) (filled circles = adult; unfilled circles = child).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2279141&req=5

Figure 2: Adult and child health costs as % of monthly expenditure (US $) (filled circles = adult; unfilled circles = child).
Mentions: Monthly household expenditure varied widely from $9–174 and did not differ significantly between those attending the private and government clinics (p = 0.826, Mann-Whitney U test). Median monthly expenditure was lowest in the households of children presenting to the private clinic (US$36.96) and highest in the households of adults presenting at the private clinics (US$41.3). Health costs over the 21 day study period ranged from $0.1–19.3 (median 1.1) and were proportionally significantly higher (p < 0.001, Mann-Whitney U test) in patients with a household expenditure of ≤ $40/month (i.e. the lowest quintile of household expenditure) compared to those with household expenditure $40–200 (Figure 2). Matching data about loss of earnings (i.e. indirect costs) and monthly expenditure was available for 20 adults and 38 carers. The amount of earnings lost through ill health or by having to take time off work to look after a sick family member varied widely from <$0.01 – $21.7. The median proportion of monthly expenditure that these lost earnings represented was 2.1% for those with expenditures <$40/month and 1.3% for those with expenditure >$40/month (p = 0.229, Mann-Whitney U test).

Bottom Line: Diagnosis based solely on clinical symptoms overdiagnosed 23% of children (<16y) and 31% of adults with malaria.Symptoms persisted (p = 0.023) and new ones developed (p < 0.001) in more adults than children in the three weeks following initial presentation.Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources.

View Article: PubMed Central - HTML - PubMed

Affiliation: Disease Control Strategy Group, Liverpool School of Tropical Medicine, Liverpool, UK. humej@niaid.nih.gov

ABSTRACT

Background: 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 overdiagnosis rates are estimated to range between 30-70%.

Methods: This paper details an observational cohort study documenting the number and cost of repeat consultations as a result of malaria overdiagnosis 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).

Results: Diagnosis based solely on clinical symptoms overdiagnosed 23% of children (<16y) and 31% of adults with malaria. Symptoms persisted (p = 0.023) and new ones developed (p < 0.001) in more adults than children in the three weeks following initial presentation. Adults overdiagnosed with malaria had more repeat visits (67% v 46%, p = 0.01-0.06) compared to those with true malaria. There was no difference in costs between patients correctly or incorrectly diagnosed with malaria. Median costs over three weeks were $0.28 for those who had one visit and $0.76 for > or = 3 visits and were proportionally highest among the poorest (p < 0.001)

Conclusion: Overdiagnosis of malaria results in a greater number of healthcare visits and associated cost for adult patients. Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources. Thus, investment in accurate malaria diagnosis and appropriate management at primary level is critical for improving health outcomes and reducing poverty.

Show MeSH
Related in: MedlinePlus