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Cost effectiveness of pre-referral antimalarial treatment in severe malaria among children in sub-Saharan Africa

Overview of attention for article published in Cost Effectiveness and Resource Allocation, July 2017
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Title
Cost effectiveness of pre-referral antimalarial treatment in severe malaria among children in sub-Saharan Africa
Published in
Cost Effectiveness and Resource Allocation, July 2017
DOI 10.1186/s12962-017-0076-5
Pubmed ID
Authors

Vivian Rakuomi, Faith Okalebo, Stanley Ndwigah, Levi Mbugua

Abstract

In 2013, 78% of malaria deaths occurred in children aged 5 years and below, in sub-Saharan Africa. Treatment of severe malaria requires a health facility with inpatient care. However, in most sub-Sahara African countries, access to health facilities is a major problem. Pre-referral antimalarial treatments aim to delay the progress of severe malaria as patients seek to access health facilities. Rectal artesunate can be administered in the community as a pre-referral treatment in rural hard-to-reach areas. In Kenya, though pre-referral rectal artesunate has been included in the National Guidelines for pre-referral treatment, it is yet to be implemented in the public healthcare system. It is important, therefore, to establish its cost-utility compared to current parenteral treatments. This study evaluated the cost-utility of provision of pre-referral treatments by community health workers compared to similar services at a primary health facility. This was a decision model-based cost-utility analysis, comparing pre-referral antimalarial treatments provided by: community health workers (CHWs), primary health facility, direct access to a tertiary health facility and no access to treatment. A theoretical cohort, of 1000 children, who were below 5 years old; residing in rural hard-to-reach areas, was taken as the reference population. Data was collected through key informant interviews, to assess the costs, while key measures of effectiveness, were obtained from existing studies. The key measure of outcomes was Disability Adjusted Life Years (DALYS) averted. Probabilistic sensitivity analysis was carried out to assess the robustness of the model. Provision of rectal pre-referral treatment by community health workers was estimated to avert 13,276 DALYs, at a cost of $68,428 for a cohort of 1000 children. Provision of rectal pre-referral treatment at a primary health facility was estimated to avert 9993 DALYs, at a cost of $73,826 for a cohort of 1000 children, while going directly to a tertiary health facility was estimated to avert 15,801 DALYs, at a cost of $114,903 for a cohort of 1000 children. The incremental cost effectiveness ratios for provision of pre-referral treatment by community health care and primary health workers were $5.11 and $7.30 per DALYs averted respectively. Use of CHWs was more cost effective than provision of pre-referral treatments at a primary health facility especially, with high referral compliance. Rectal artesunate can easily be administered by community health workers, unlike parenteral pre-referral interventions.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 81 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 81 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 16 20%
Student > Bachelor 10 12%
Student > Postgraduate 8 10%
Researcher 6 7%
Lecturer 5 6%
Other 14 17%
Unknown 22 27%
Readers by discipline Count As %
Nursing and Health Professions 15 19%
Medicine and Dentistry 14 17%
Pharmacology, Toxicology and Pharmaceutical Science 6 7%
Social Sciences 5 6%
Agricultural and Biological Sciences 5 6%
Other 11 14%
Unknown 25 31%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 21 July 2017.
All research outputs
#14,072,753
of 22,988,380 outputs
Outputs from Cost Effectiveness and Resource Allocation
#287
of 432 outputs
Outputs of similar age
#167,981
of 312,506 outputs
Outputs of similar age from Cost Effectiveness and Resource Allocation
#3
of 9 outputs
Altmetric has tracked 22,988,380 research outputs across all sources so far. This one is in the 37th percentile – i.e., 37% of other outputs scored the same or lower than it.
So far Altmetric has tracked 432 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 8.1. This one is in the 32nd percentile – i.e., 32% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 312,506 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 44th percentile – i.e., 44% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 9 others from the same source and published within six weeks on either side of this one. This one has scored higher than 6 of them.