| ObjectiveTo understand the current cost of malaria treatment expenditures of malaria patients in The Democratic Republic of Sao Tome and Principe(Abbreviated as "STP")by analyzing the economic burden of disease and the factors influencing malaria cases before and after the project named Mass Administration Drug(MDA)of artemisinin piperaquine tablets in villages with high malaria prevalence in STP,and to explore the main influencing factors;and to comparing the changes in direct medical costs,direct non-medical costs,direct economic burden and indirect economic burden of malaria before and after MDA,and exploring the impact of MDA on the economic burden of malaria in STP.MethodsA baseline survey was conducted in STP,including information on local population size,gender,occupation,number of surveyed local health centers as well as health sites,number of medical staff,and number of weekly reported cases of malaria from 2017 to 2021.Villages with consistently high annual malaria incidence from 2017 to 2021 were selected for three rounds of universal access to artemisinin-piperaquine tablets.For the implementation area before the MDA,a retrospective survey method was used to survey the economic burden questionnaire of cases who had had malaria in 2021.During the process of MDA,information including the rate of drug administration and the distribution of people who did not take the drug was collected and collated to clarify the status of this MDA implementation for the whole population.The economic burden questionnaire survey was conducted again for new malaria cases every month during and three months after the end of the three rounds of MDA,using the date of implementation of MDA as the boundary,and the questionnaire information generally included patients’ gender,age,occupation,duration of disease onset,institutions visited,days missed from work and other information and treatment costs.The SPSS 25.0 software was applied for analysis,and the median and interquartile spacing were used to describe the measurement data that did not conform to normal distribution,the rank sum test for two independent samples was used for comparison between two groups,the χ2 test was used for counting data,and the rank sum test was used for one-way analysis of factors that might affect the economic burden of malaria patients(Mann-Whitney U test was used for variables in 2 groups,and the KruskalWhitney U test was used for variables in 3 groups and above variables using KruskalWallis H test),and binary logistic regression analysis was done for statistically significant influencing factors,and differences were considered statistically significant at P<0.05.ResultsA total of 12,535 malaria cases were recorded and reported in the whole country of STP from 2017-2021,of which a total of 42 imported cases.The main cases in the country were indigenous cases,with fewer imported cases.The proportion of patients in the age group of 5 to 15 years was relatively high,and there was no significant change in the age composition of malaria cases from 2017-2021.In terms of the occupation of patients,the occupation of disease cases infected with malaria in STP was dominated by students(45.69%),followed by cases not currently working or staying at home(19.10%).The number of cases of malaria between week 31 and week 45 was relatively low according to the number of cases reported weekly.The median direct economic burden was 58.57 yuan for outpatients and 357.14 yuan for inpatient cases;the median indirect economic burden was 346.64 yuan for both outpatient and inpatient cases and relatives with comparable time missed from work due to illness,according to the economic burden questionnaire collected from 126 cases before the MDA.After analysis of the importance of the factors influencing the economic burden before MDA,the six variables of consultation institution,duration of morbidity,age,occupation,education level and mode of consultation had the greatest influence on the direct economic burden of malaria.Duration of morbidity,education level,age,occupation and mode of consultation were the most important factors influencing the indirect economic burden.The most important factor influencing the overall economic burden is the duration of the patient’s illness,followed by the patient’s visiting institution,literacy level,mode of treatment and occupation.The medication coverage rates of the three rounds of MDA were 87.48%,85.98%and 86.14%,respectively.The differences in age,gender,literacy and occupation of the patients before and after MDA were not statistically significant the differences in the place of consultation were statistically significant.The median direct economic burden,indirect economic burden,and overall economic burden of patients after MDA were 35.7 yuan,216.65 yuan,and 259.91 yuan,respectively;compared with the pre-MDA,each economic burden decreased by approximately 46.24%,41.18%,and 49.46%,respectively.The number of days missed from work for patients and their relatives decreased by 5 days after MDA compared with pre-MDA;the MDA The differences in direct medical costs,direct non-medical costs,and direct,indirect,and overall economic burden before and after MDA were all statistically significant(P<0.05).By different demographic characteristics,the economic burden was lower after MDA than before MDA for patients in the age groups of 5 to 14 years,15 to 49 years and 50 to 69 years,patients in the middle-income level and low-income level,patients in the commercial and service sectors and those who were homebound or engaged in domestic activities,as well as for this group of cases seen between different institutions.economic burden.ConclusionThe economic burden of patients after the MDA was lower than before the MDA,as evidenced by the reduction in direct medical costs and days missed from work,which was associated with guaranteed dosing rates and active monitoring and maintenance by health care workers at a later stage. |
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