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BMC Public Health

, 17:572

Health policies, systems and management in low and middle-income countries


BackgroundThe expansion of malaria prevention and control to school-aged children is receiving increasing attention, but there are still limited data on the costs of intervention. This paper analyses the costs of a comprehensive school-based intervention strategy, delivered by teachers, that included participatory malaria educational activities, distribution of long lasting insecticide-treated nets LLIN, and Intermittent Parasite Clearance in schools IPCs in southern Mali.

MethodsCosts were collected alongside a randomised controlled trial conducted in 80 primary schools in Sikasso Region in Mali in 2010-2012. Cost data were compiled between November 2011 and March 2012 for the 40 intervention schools 6413 children. A provider perspective was adopted. Using an ingredients approach, costs were classified by cost category and by activity. Total costs and cost per child were estimated for the actual intervention, as well as for a simpler version of the programme more suited for scale-up by the government. Univariate sensitivity analysis was performed.

ResultsThe economic cost of the comprehensive intervention was estimated to $10.38 per child financial cost $8.41 with malaria education, LLIN distribution and IPCs costing $2.13 20.5%, $5.53 53.3% and $2.72 26.2% per child respectively. Human resources were found to be the key cost driver, and training costs were the greatest contributor to overall programme costs. Sensitivity analysis showed that an adapted intervention delivering one LLIN instead of two would lower the economic cost to $8.66 per child; and that excluding LLIN distribution in schools altogether, for example in settings where malaria control already includes universal distribution of LLINs at community-level, would reduce costs to $4.89 per child.

ConclusionsA comprehensive school-based control strategy may be a feasible and affordable way to address the burden of malaria among schoolchildren in the Sahel.

KeywordsMalaria Cost analysis Malaria control Schools School health LLINs Intermittent treatment IPCs IPT Programme costs Mali AbbreviationsACTArtemisin-based Combination Therapy



CDACommunity Development Agent

DTCDirecteur Technicien de Santé Communautaire

INGOInternational Non-Governmental Organisation

INRSPInstitute National de Recherche en Santé Publique

IPCsIntermittent Parasite Clearance in schools

ITNInsecticide-Treated Net

LLINLong lasting insecticidal net

LSHTMLondon School of Hygiene and Tropical Medicine

PNLPProgramme National de Lutte contre le Paludisme

SPSulfadoxine Pyrimethamine

STCSave The Children

USDUnited States Dollars

WHOWorld Health Organization

XOFWest African Francs Francs de la Communauté Financière Africaine

Electronic supplementary materialThe online version of this article doi:10.1186-s12889-017-4490-6 contains supplementary material, which is available to authorized users.

Autor: Roberta Maccario - Saba Rouhani - Tom Drake - Annie Nagy - Modibo Bamadio - Seybou Diarra - Souleymane Djanken - Natalie R


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