Costs and barriers faced by households seeking malaria treatment in the Upper River Region, The Gambia

• Published in: Malaria journal Vol. 20; no. 1; p. 368
• Main Authors: Broekhuizen, Henk, Fehr, Alexandra, Nieto-Sanchez, Claudia, Muela, Joan, Peeters-Grietens, Koen, Smekens, Tom, Kalleh, Momodou, Rijndertse, Esmé, Achan, Jane, D'Alessandro, Umberto
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.09.2021; BioMed Central; BMC
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Care and treatment; Child; Child, Preschool; Children & youth; Cost analysis; Costs; Disease transmission; Economic aspects; Family; Family Characteristics; Female; Gambia; Health aspects; Health Expenditures - statistics & numerical data; Health facilities; Households; Human diseases; Humans; Infant; Intervention; Malaria; Malaria - prevention & control; Male; Medical care, Cost of; Methods; Middle Aged; Out-of-pocket expenses; Participation; Patient Acceptance of Health Care - statistics & numerical data; Polls & surveys; Subsistence agriculture; Surveying; Surveys; Vector-borne diseases; Young Adult; Gambia; Africa
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-021-03898-6

Malaria transmission in The Gambia decreased substantially over the last 20 years thanks to the scale-up of control interventions. However, malaria prevalence is still relatively high in eastern Gambia and represents both a health and a financial burden for households. This study aims to quantify the out-of-pocket costs and productivity losses of seeking malaria treatment at household level. A household survey was carried out through in-person interviews. Respondents were asked about malaria prevention methods, their treatment-seeking behaviour, and any costs incurred for transport, services, food, and/or overnight stays. A bottom-up costing approach was used to calculate the unit cost of treatment and a tobit regression approach to investigate cost drivers. The survey included 864 respondents, mainly subsistence farmers. Most respondents (87%) considered malaria to be a problem affecting their ability to perform their regular duties. Respondents preferred going to a health facility for treatment. The primary reason for not going was related to costs; 70% of respondents incurred costs for seeking health care, with a median of £3.62 (IQR: £1.73 to £6.10). The primary driver of cost was living in one of the villages that are off the main road and/or far from health facilities. 66% reported productivity loss of 5 working days on average during a malaria episode of them or their child. Although malaria prevalence is decreasing and treatment is provided free of charge, households seeking treatment are confronted with out-of-pocket expenditures and lost working days; particularly in remote villages.