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Socioeconomic inequalities, equity effect, and cost-effectiveness of malaria control interventions in an endemic area of western Kenya

Were, Vincent (2019) Socioeconomic inequalities, equity effect, and cost-effectiveness of malaria control interventions in an endemic area of western Kenya, Thesis (Doctoral), Liverpool School of Tropical Medicine.

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Malaria control in endemic areas still faces the challenge of ensuring that scale-up of interventions is sustainable, cost-effective and equitable. However, there have not been adequate studies monitoring equity effects or changes in socioeconomic inequalities of these
Interventions over time even. The existence of socioeconomic health inequalities is a barrier to achieve universal health coverage and sustainable development goals.

Methods: Secondary datasets have been used in these microeconomic evaluations including eight years of repeated annual cross-sectional surveys from 2006 to 2013 involving 19,000 individuals in Siaya County, western Kenya. Data from a two-year cluster randomized Mass Test and Treat (MTAT) study conducted between 2013 and 2015 were also used. Further, malaria-related mortality and morbidity data from health and demographic surveillance system (HDSS) surveys from 2006 to 2014 have been used. Lastly, data on costs and effects of Long-Lasting Insecticide Nets (LLIN) distribution channels were collected from national to local levels in Busia County, western Kenya to assess the cost-effectiveness of LLIN distribution channels from a provider and household perspectives. Household socioeconomic status (SES) was established using multiple correspondence analysis (MCA), socioeconomic inequalities were assessed using concentration indices, and multi-level mixed-effects generalized linear regression models (GLM) were used to compare prevalence ratios with 95% confidence intervals. Disability-adjusted life years and cost-effectiveness ratios were calculated to answer research questions. Data were compared between the poorest and less poor individuals at the household and population level.

Results: The poorest individuals, children, and women, bore the greatest burden of malaria measured in terms of morbidity, mortalities and disability-adjusted life years but the health inequality gap between the poor and less poor has reduced over time. There were no significant inequalities in medication use and care-seeking for fever between the poorest and less poor which represents equity gains for the poorest individuals. The MTAT intervention resulted in equity gains amongst the socio-economic groups in terms of access to medication, care-seeking, use of LLINs and averting malaria deaths in the participating communities. Mass distribution of LLINs combined with the use of community health volunteers remains the most cost-effective and equitable method of achieving universal coverage.

Discussion. Malaria remains a disease of poor individuals across age groups and gender but is mostly concentrated amongst children and women. While intensification of malaria control activities has resulted in a reduction of socioeconomic inequalities in rates of infections, mortality, care seeking and medication for fever, pro-poor and mass campaigns for control interventions should be to be integrated to reduce inequalities and inequities. The results from these studies are vital for monitoring socioeconomic inequalities and equity trends towards achieving universal health coverage and sustainable development goals.

Item Type: Thesis (Doctoral)
Subjects: WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 765 Prevention and control
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Depositing User: Lynn Roberts-Maloney
Date Deposited: 08 Nov 2019 09:32
Last Modified: 09 Feb 2020 02:02


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