Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England.
PLoS One. 2011;6(11):e24871. doi: 10.1371/journal.pone.0024871. Epub 2011 Nov 3.
Intermittent preventive treatment of malaria in children (IPTc) involves the administration of a course of anti-malarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected. IPTc provides a high level of protection against uncomplicated and severe malaria, with monthly sulphadoxine-pyrimethamine plus amodiaquine (SP&AQ) and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens. A key challenge is the identification of a cost-effective delivery strategy.
A community randomized trial was undertaken in Jasikan district, Ghana to assess IPTc effectiveness and costs using SP&AQ delivered in three different ways. Twelve villages were randomly selected to receive IPTc from village health workers (VHWs) or facility-based nurses working at health centres' outpatient departments (OPD) or EPI outreach clinics. Children aged 3 to 59 months-old received one IPT course (three doses) in May, June, September and October. Effectiveness was measured in terms of children covered and adherent to a course and delivery costs were calculated in financial and economic terms using an ingredient approach from the provider perspective.
The economic cost per child receiving at least the first dose of all 4 courses was US$4.58 when IPTc was delivered by VHWs, US$4.93 by OPD nurses and US$ 5.65 by EPI nurses. The unit economic cost of receiving all 3 doses of all 4 courses was US$7.56 and US$8.51 when IPTc was delivered by VHWs or facility-based nurses respectively. The main cost driver for the VHW delivery was supervision, reflecting resources used for travelling to more remote communities rather than more intense supervision, and for OPD and EPI delivery, it was the opportunity cost of the time spent by nurses in dispensing IPTc.
VHWs achieve higher IPTc coverage and adherence at lower costs than facility-based nurses in Jasikan district, Ghana.
ClinicalTrials.gov NCT00119132.
儿童间歇性预防治疗疟疾（IPTc）是指在疟疾风险儿童中，无论其是否已知感染，都在特定时间间隔内给予抗疟药物疗程。IPTc 对无并发症和严重疟疾提供高度保护，每月给予磺胺多辛-乙胺嘧啶加阿莫地喹（SP&AQ）和磺胺多辛-乙胺嘧啶加哌喹是最有效的方案。一个关键的挑战是确定具有成本效益的交付策略。
在加纳 Jasikan 区进行了一项社区随机试验，使用三种不同方式给予 SP&AQ，评估 IPTc 的效果和成本。随机选择 12 个村庄，由乡村卫生工作者（VHW）、在卫生中心门诊部门（OPD）或 EPI 外展诊所工作的医护人员提供 IPTc。3 至 59 个月大的儿童在 5 月、6 月、9 月和 10 月接受一次 IPT 疗程（三剂）。效果以接受至少一个疗程的儿童比例和接受治疗的儿童比例衡量，从提供者角度使用成分方法，以财务和经济术语计算交付成本。
当由 VHW 提供 IPTc 时，每个接受至少前四剂全部四剂的儿童的经济成本为 4.58 美元，由 OPD 护士提供为 4.93 美元，由 EPI 护士提供为 5.65 美元。当由 VHW 或医疗机构护士提供 IPTc 时，每个接受全部四剂的三个剂量的单位经济成本分别为 7.56 美元和 8.51 美元。VHW 提供的主要成本驱动因素是监督，反映了用于前往较偏远社区的资源，而不是更密集的监督，而 OPD 和 EPI 提供的主要成本驱动因素是护士在分发 IPTc 时的机会成本。
在加纳 Jasikan 区，VHW 提供 IPTc 的覆盖率和接受率高于医疗机构护士，成本更低。
ClinicalTrials.gov NCT00119132。
