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Cost implications of improving malaria diagnosis: findings from north-eastern Tanzania.

Mosha JF, Conteh L, Tediosi F, Gesase S, Bruce J, Chandramohan D, Gosling R - PLoS ONE (2010)

Bottom Line: Pattern of causes of illness observed in a <2 year old cohort of children over one year was compared to the pattern of causes of illness in <5 year old children recorded in the routine health care system during the same period.A higher proportion of children were diagnosed with ARI in the <2 year old cohort compared to children seen at the routine care system ( 42% vs 26%; p<0.001).Using a RDT reduced overall drug and diagnostic costs by 10% in the high transmission site and by 15% in the low transmission site compared to total diagnostic and drug costs of treatment based on clinical judgment in routine health care system.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Medical Research, Mwanza, Tanzania.

ABSTRACT

Background: Over diagnosis of malaria contributes to improper treatment, wastage of drugs and resistance to the few available drugs. This paper attempts to estimate the rates of over diagnosis of malaria among children attending dispensaries in rural Tanzania and examines the potential cost implications of improving the quality of diagnosis.

Methodology/principal findings: The magnitude of over diagnosis of malaria was estimated by comparing the proportion of outpatient attendees of all ages clinically diagnosed as malaria to the proportion of attendees having a positive malaria rapid diagnostic test over a two month period. Pattern of causes of illness observed in a <2 year old cohort of children over one year was compared to the pattern of causes of illness in <5 year old children recorded in the routine health care system during the same period. Drug and diagnostic costs were modelled using local and international prices. Over diagnosis of malaria by the routine outpatient care system compared to RDT confirmed cases of malaria was highest among <5 year old children in the low transmission site (RR 17.9, 95% CI 5.8-55.3) followed by the >or=5 year age group in the lower transmission site (RR 14.0 95%CI 8.2-24.2). In the low transmission site the proportion of morbidity attributable to malaria was substantially lower in <2 year old cohort compared to children seen at routine care system. (0.08% vs 28.2%; p<0.001). A higher proportion of children were diagnosed with ARI in the <2 year old cohort compared to children seen at the routine care system ( 42% vs 26%; p<0.001). Using a RDT reduced overall drug and diagnostic costs by 10% in the high transmission site and by 15% in the low transmission site compared to total diagnostic and drug costs of treatment based on clinical judgment in routine health care system.

Implications: The introduction of RDTs is likely to lead to financial savings. However, improving diagnosis to one disease may lead to over diagnosis of another illness. Quality improvement is complex but introducing RDTs for the diagnosis of malaria is a good start.

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Related in: MedlinePlus

Study sites.
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pone-0008707-g001: Study sites.

Mentions: The study was conducted in a low and a moderate malaria transmission area in Tanzania. The low transmission site, Same, located in Kilimanjaro region (Figure 1, is semi-arid, with altitude ranging from 600m to 1000m in the plain and reaching up to 1900m in mountainous areas. Annual rainfall is low and seasonal, the main rains falling between March and June (mean annual rainfall 1996–2006 588ml range 265–1021ml). Incidence of malaria was recorded as 0.018 per child per year in children aged 2–24 months of age between 2005–2008 [20]. Health facilities included in the study were 1 district hospital in an urban setting (Same District Hospital), 1 health centre (Ndungu) and 2 dispensaries (Kiswani and Gonja Moare), situated in small rural townships.


Cost implications of improving malaria diagnosis: findings from north-eastern Tanzania.

Mosha JF, Conteh L, Tediosi F, Gesase S, Bruce J, Chandramohan D, Gosling R - PLoS ONE (2010)

Study sites.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2806838&req=5

pone-0008707-g001: Study sites.
Mentions: The study was conducted in a low and a moderate malaria transmission area in Tanzania. The low transmission site, Same, located in Kilimanjaro region (Figure 1, is semi-arid, with altitude ranging from 600m to 1000m in the plain and reaching up to 1900m in mountainous areas. Annual rainfall is low and seasonal, the main rains falling between March and June (mean annual rainfall 1996–2006 588ml range 265–1021ml). Incidence of malaria was recorded as 0.018 per child per year in children aged 2–24 months of age between 2005–2008 [20]. Health facilities included in the study were 1 district hospital in an urban setting (Same District Hospital), 1 health centre (Ndungu) and 2 dispensaries (Kiswani and Gonja Moare), situated in small rural townships.

Bottom Line: Pattern of causes of illness observed in a <2 year old cohort of children over one year was compared to the pattern of causes of illness in <5 year old children recorded in the routine health care system during the same period.A higher proportion of children were diagnosed with ARI in the <2 year old cohort compared to children seen at the routine care system ( 42% vs 26%; p<0.001).Using a RDT reduced overall drug and diagnostic costs by 10% in the high transmission site and by 15% in the low transmission site compared to total diagnostic and drug costs of treatment based on clinical judgment in routine health care system.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Medical Research, Mwanza, Tanzania.

ABSTRACT

Background: Over diagnosis of malaria contributes to improper treatment, wastage of drugs and resistance to the few available drugs. This paper attempts to estimate the rates of over diagnosis of malaria among children attending dispensaries in rural Tanzania and examines the potential cost implications of improving the quality of diagnosis.

Methodology/principal findings: The magnitude of over diagnosis of malaria was estimated by comparing the proportion of outpatient attendees of all ages clinically diagnosed as malaria to the proportion of attendees having a positive malaria rapid diagnostic test over a two month period. Pattern of causes of illness observed in a <2 year old cohort of children over one year was compared to the pattern of causes of illness in <5 year old children recorded in the routine health care system during the same period. Drug and diagnostic costs were modelled using local and international prices. Over diagnosis of malaria by the routine outpatient care system compared to RDT confirmed cases of malaria was highest among <5 year old children in the low transmission site (RR 17.9, 95% CI 5.8-55.3) followed by the >or=5 year age group in the lower transmission site (RR 14.0 95%CI 8.2-24.2). In the low transmission site the proportion of morbidity attributable to malaria was substantially lower in <2 year old cohort compared to children seen at routine care system. (0.08% vs 28.2%; p<0.001). A higher proportion of children were diagnosed with ARI in the <2 year old cohort compared to children seen at the routine care system ( 42% vs 26%; p<0.001). Using a RDT reduced overall drug and diagnostic costs by 10% in the high transmission site and by 15% in the low transmission site compared to total diagnostic and drug costs of treatment based on clinical judgment in routine health care system.

Implications: The introduction of RDTs is likely to lead to financial savings. However, improving diagnosis to one disease may lead to over diagnosis of another illness. Quality improvement is complex but introducing RDTs for the diagnosis of malaria is a good start.

Show MeSH
Related in: MedlinePlus