Intermittent preventive treatment of malaria in pregnancy: the incremental cost-effectiveness of a new delivery system in Uganda

Jun 3, 2008Transactions of the Royal Society of Tropical Medicine and Hygiene

Cost-effectiveness of a new way to deliver malaria prevention during pregnancy in Uganda

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Abstract

Among 2785 pregnant women, 67.5% in community-based care completed two doses of IPTp compared to 39.9% at health centres.

Community-based care resulted in a higher proportion of women receiving and adhering to two doses of IPTp.
Women in community care experienced fewer episodes of anaemia and fewer cases of severe anaemia.
The incidence of low birth weight babies was lower among women receiving community-based care.
The cost per woman for community delivery of IPTp was US$2.60, slightly higher than US$2.30 at health centres.
The cost-effectiveness ratio for community delivery was Uganda shillings 1869 (US$1.10) per lost disability-adjusted life-year (DALY) averted.

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The main objective of this study was to assess whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilisers could administer intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) to pregnant women. The study was implemented in 21 community clusters (intervention) and four clusters where health centres provided routine IPTp (control). The primary outcome measures were the proportion of women who completed two doses of SP; the effect on anaemia, parasitaemia and low birth weight; and the incremental cost-effectiveness of the intervention. The study enrolled 2785 pregnant women. The majority, 1404/2081 (67.5%) receiving community-based care, received SP early and adhered to the two recommended doses compared with 281/704 (39.9%) at health centres (P<0.001). In addition, women receiving community-based care had fewer episodes of anaemia or severe anaemia and fewer low birth weight babies. The cost per woman receiving the full course of IPTp was, however, higher when delivered via community care at US$2.60 compared with US$2.30 at health centres, due to the additional training costs. The incremental cost-effectiveness ratio of the community delivery system was Uganda shillings 1869 (US$1.10) per lost disability-adjusted life-year (DALY) averted. In conclusion, community-based delivery increased access and adherence to IPTp and was cost-effective.

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Intermittent preventive treatment of malaria in pregnancy: the incremental cost-effectiveness of a new delivery system in Uganda

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