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PROVIDING PRACTICAL ESTIMATES OF MALARIA BURDEN FOR HEALTH PLANNERS IN RESOURCE-POOR COUNTRIES

In many countries in sub-Saharan Africa, estimates of malaria occurrence used by health planners at all levels are based on data from formal sector health facilities. Since the majority of fever episodes are treated at home and within the community, the burden estimates obtained this way are the tips of the iceberg. A case study from Ghana comparing household data on acute morbidity and treatment-seeking behavior in two districts with health facility data is used as an illustration. For every case of febrile illness seen in the health facilities, there were approximately 4-5 in the community. Many sub-Saharan African countries recommend that all febrile episodes, especially in children, be treated with an antimalarial. Since several countries extend malaria treatment to include the community and the home through public and private, formal and informal sectors, the need for more comprehensive burden estimates becomes urgent.

Received August 21, 2003. Accepted for publication October 7, 2003.

Acknowledgments: Some of the data in this report on community-based acute morbidity and treatment-seeking behavior was part of a larger study (Integrating Health Education into Malaria Control at District Level).

Financial support: This study was supported by the United Nations Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases.

Authors’ addresses: Irene Akua Agyepong, Regional Health Administration, Ghana Health Service, Greater Accra Region, P.O. Box 184, Adabraka, Ghana. E-mail: iagyepong{at}ighmail.com. Jane Kangeya-Kayonda, The UNICEF/UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.

^* The calculation is based on the estimate that if only 16% of the "febrile illness presumed malaria" cases used a health post or a small clinic as their treatment choice (Table 6), then for every 16 cases recorded by the routine HMIS, there are 84 other cases in the community that are not recorded. Thus, the number of cases of "febrile illness presumed malaria" actually occurring in the year would more likely be [(Total new cases recorded at the health centers) x (100/16)].

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