Browsing by Author "Castillo-Riquelme, Marianela"

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    Open Access
    Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia
    (BioMed Central Ltd, 2009) Chanda, Pascalina; Castillo-Riquelme, Marianela; Masiye, Felix
    BACKGROUND:Malaria in Zambia accounts for about 4 million clinical cases and 8 000 deaths annually. Artemether-lumefantrine (ACT), a relatively expensive drug, is being used as first line treatment of uncomplicated malaria. However, diagnostic capacity in Zambia is low, leading to potentially avoidable wastage of drugs due to unnecessary anti malarial treatment. METHODS: A cost-effectiveness evaluation of the three current alternatives to malaria diagnosis (clinical, microscopy and Rapid Diagnostic Tests- RDT) was conducted in 12 facilities from 4 districts in Zambia. The analysis was conducted along an observational study, thus reflecting practice in health facilities under routine conditions. Average and incremental cost effectiveness ratios were estimated from the providers' perspective. Effectiveness was measured in relation to malaria cases correctly diagnosed by each strategy. RESULTS: Average cost-effectiveness ratios show that RDTs were more efficient (US$ 6.5) than either microscopy (US$ 11.9) or clinical diagnosis (US$ 17.1) for malaria case correctly diagnosed. In relation to clinical diagnoses the incremental cost per case correctly diagnosed and treated was US$ 2.6 and US$ 9.6 for RDT and microscopy respectively. RDTs would be much cheaper to scale up than microscopy. The findings were robust to changes in assumptions and various parameters. CONCLUSION: RDTs were the most cost effective method at correctly diagnosing malaria in primary health facilities in Zambia when compared to clinical and microscopy strategies. However, the treatment prescription practices of the health workers can impact on the potential that a diagnostic test has to lead to savings on antimalarials. The results of this study will serve to inform policy makers on which alternatives will be most efficient in reducing malaria misdiagnosis by taking into account both the costs and effects of each strategy.
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    Factors influencing malaria care seeking behaviour in two Ghanaian communities : formal versus informal malaria care
    (2008) Saweka, Delfina Ângela; Castillo-Riquelme, Marianela
    The study primary objective was to investigate the determinants and extent of household’s reliance on the informal malaria care sector in two Ghanaians communities. The secondary objective wass to inform policy-makers and planners, especially from the public healthcare sector, on supply side issues that are likely to influence the current malaria care seeking patterns.
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    The burden of HIV/AIDS in the public health care system
    (2008) Cleary, Susan; Boulle, Andrew; Castillo-Riquelme, Marianela; Mcintyre, Di
    Given current lack of routine data, assessing the burden of HIV/AIDS on the public healthcare system is complex. This research aimed to collect a wide range of data that could be used to estimate this burden and the costs of meeting it. Data collection was undertaken by research doctors who were employed in a wide spectrum of facilities to compile information on patients' HIV-status, retrospective utilisation of services and unit costs of care. Key results indicated that the percentage of expenditure on HIV-related care was 26% across all facilities. HIV-positive patients had higher utilisation of services compared to other patient groups; the annual cost per patient was estimated to be R4,813 (2007/08 prices). Results should be interpreted in the light of the underlying population need and context-specific access barriers.