Household Expenditure on Prevention and Treatment of Malaria in Khartoum State during a Transmission Season September 2003.

Malaria represents a major public health problem in Khartoum State. It is responsible for 24% of disease episodes seen at outpatient departments.,13.4% of inpatients admittance and 10% of hospital deaths. Combating malaria needs mutual efforts from both the government and the community. For the successful implementation of control measures, the economic impact of malaria on households as a whole, and in different subgroups of the population need to be known. This is needed first to target the population by equitable and efficient interventions. And second to promote the uptake of preventive measures by the households and guide them in their care seeking practices. This study was conducted to estimate the out-of-pocket expenditure related to malaria prevention and treatment by households, and the effects of care seeking behaviour, socioeconomic status, health insurance coverage and residential area on these expenditures, during the transmission season in Khartoum State during the year 2003. A total of 904 households, selected by the stratified, cluster sampling techniques, were included in the study. Two pre-tested questionnaires were used to collect retrospective data about prevention practices and prevention expenditure. Data about care seeking behaviour during simple malaria episodes and expenditure on malaria treatment during September 2003 were also collected. The results revealed a low use of preventive measures in all sectors of the population and especially among those of low socioeconomic status and residents of rural areas and camps. There was no significant difference in the incidence of malaria among the different income groups. On the other hand rural areas and camps had a significantly higher incidence than urban areas. There was a high rate of health facility use and low rate of self treatment for malaria management. Use of governmental health facilities was higher than use of private facilities. The mean annual expenditure on malaria prevention was 2944 VII Sudanese Dinars (SD) (5517) per household, and the median was 1400 SD. This depleted 0.6% of the annual income of the population. The mean monthly expenditure on malaria treatment per household was 2710 SD (2191) and the median was 1100SD, depleting 5.9% of the monthly income of the population. In both instances, and in absolute terms, the expenditures were low for low income groups and for those residing in rural areas and camps. However, on relative terms households from low income groups and rural areas and camps suffer a greater burden. The expenditure on treatment per fully cured patient was 1391 SD (1334) and the median was1070SD. It was lower for those with Health Insurance Corporation coverage. It was higher for those who used health facilities, especially those of the private sector. Expenditure on drugs comprised the greatest proportion of all treatment expenditure (45.1%), and this proportion is anticipated to increase even more after the adoption of new combination therapy. It was concluded that malaria places a tremendous economic burden on households of Khartoum state especially those of low socioeconomic status and those residing in rural areas and camps. The relatively high treatment expenditure compared to preventive expenditure can be due to the high accessibility to health services in the Khartoum and low coverage by health insurance in one hand and low preventive measures uptake by the population on the other hand. It is thus recommended that this economic burden should be reduced through: • Increasing coverage by preventive measures to reduce treatment costs in long run. • Expanding coverage by health insurance. • Educating the population on how to channel their expenditure rationally and insuring rational use of drug at facility level. VIII • Studies to quantify the indirect cost of malaria including cost of treating malaria on an inpatient bases, should be conducted to reflect the whole burden that falls on households