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The Cost of Uncomplicated Childhood Fevers to Kenyan Households: Implications for Reaching International Access Targets

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dc.contributor.author Larson, Bruce A en_US
dc.contributor.author Amin, Abdinasir A en_US
dc.contributor.author Noor, Abdisalan M en_US
dc.contributor.author Zurovac, Dejan en_US
dc.contributor.author Snow, Robert W en_US
dc.date.accessioned 2012-01-11T21:40:47Z
dc.date.available 2012-01-11T21:40:47Z
dc.date.copyright 2006 en_US
dc.date.issued 2006-12-29 en_US
dc.identifier.citation Larson, Bruce A, Abdinasir A Amin, Abdisalan M Noor, Dejan Zurovac, Robert W Snow. "The cost of uncomplicated childhood fevers to Kenyan households: implications for reaching international access targets" BMC Public Health 6:314. (2006) en_US
dc.identifier.issn 1471-2458 en_US
dc.identifier.uri http://hdl.handle.net/2144/3231
dc.description.abstract BACKGROUND. Fever is the clinical hallmark of malaria disease. The Roll Back Malaria (RBM) movement promotes prompt, effective treatment of childhood fevers as a key component to achieving its optimistic mortality reduction goals by 2010. A neglected concern is how communities will access these new medicines promptly and the costs to poor households when they are located in rural areas distant to health services. METHODS. We assemble data developed between 2001 and 2002 in Kenya to describe treatment choices made by rural households to treat a child's fever and the related costs to households. Using a cost-of-illness approach, we estimate the expected cost of a childhood fever to Kenyan households in 2002. We develop two scenarios to explore how expected costs to households would change if more children were treated at a health care facility with an effective antimalarial within 48 hours of fever onset. RESULTS. 30% of uncomplicated fevers were managed at home with modern medicines, 38% were taken to a health care facility (HCF), and 32% were managed at home without the use of modern medicines. Direct household cash expenditures were estimated at $0.44 per fever, while the total expected cost to households (cash and time) of an uncomplicated childhood fever is estimated to be $1.91. An estimated mean of 1.42 days of caretaker time devoted to each fever accounts for the majority of household costs of managing fevers. The aggregate cost to Kenyan households of managing uncomplicated childhood fevers was at least $96 million in 2002, equivalent to 1.00% of the Kenyan GDP. Fewer than 8% of all fevers were treated with an antimalarial drug within 24 hours of fever onset, while 17.5% were treated within 48 hours at a HCF. To achieve an increase from 17.5% to 33% of fevers treated with an antimalarial drug within 48 hours at a HCF (Scenario 1), children already being taken to a HCF would need to be taken earlier. Under this scenario, direct cash expenditures would not change, and total household costs would fall slightly to $1.86 because caretakers also save time with prompt treatment if the child has malaria. CONCLUSION. The management of uncomplicated childhood fevers imposes substantial costs on Kenyan households. Achieving substantial improvements in the numbers of fevers treated within 48 hours at a HCF with an effective antimalarial drug (Scenario 1) will not impose additional costs on households. Achieving additional improvements in fevers treated promptly at a HCF (Scenario 2) will impose additional costs on some households roughly equal to average cash expenses for transportation to a HCF. Additional financing mechanisms that further reduce the costs of accessing care at a HCF and/or that make artemisinin-based combination therapies (ACTs) accessible for home management need to be developed and evaluated as a top priority. en_US
dc.description.sponsorship Roll Back Malaria Initiative; AFRO (AF/ICP/CPC/400/XA/00); Wellcome Trust, UK; Kenya Medical Research Institute en_US
dc.language.iso en en_US
dc.publisher BioMed Central en_US
dc.rights Copyright 2006 Larson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. en_US
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_US
dc.title The Cost of Uncomplicated Childhood Fevers to Kenyan Households: Implications for Reaching International Access Targets en_US
dc.type article en_US
dc.identifier.doi 10.1186/1471-2458-6-314 en_US
dc.identifier.pubmedid 17196105 en_US
dc.identifier.pmcid 1770919 en_US


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Copyright 2006 Larson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Except where otherwise noted, this item's license is described as Copyright 2006 Larson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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