Cost-effectiveness analysis of insecticide-impregnated mosquito nets (bednets) used as a malaria control measure : a study from the Gambia.

Insecticide-impregnated bednets are currently being promoted as one of the promising malaria control methods in endemic regions of most developing countries. Although, much is known about the entomological and epidemiological aspects of treated bednets, little is known about the efficiency of malaria control programmes in general, and bednets in particular. This cost-effectiveness analysis forms part of the evaluation of the Gambian National Insecticide-impregnated Bednet Programme (NIBP). The research was conducted in the rural Gambia where malaria is endemic. An integrated approach to data collection approach (qualitative and quantitative) provided information for the four objectives of the study, namely; 1. to calculate the total NIBP implementation costs (ie' direct and indirect costs); 2. to estimate the number of child (under 10 years) deaths averted in the intervention area; 3. to calculate the resources saved by averting a child death to the health sector and households both direct (ie saved treatment costs, saved preventive expenditures, postponed funeral expenses) and indirect (ie time costs saved by carers and relatives that can be spent on productive activities) and subtract these from the programme costs, to produce net cost-effectiveness ratios and 4. to investigate the effect of impregnated bednets on primary school attendance in terms of days and reasons for absenteeism. The study covered 64 government and non-governmental organization personnel, 179 village dippers, 306 women in groups of 5 8 in focus group discussions, 25 in-depth interviews of men, 134 carers of children, 50 women in random spot observations and 2182 pupils in school attendance study. The main findings of the study were; 1. The annual implementation cost of NIBP was D757,874.72. 2. The implementation and the net cost-effectiveness ratios per child death averted were D4,946.63 and D1,332.31 respectively and, 3 . Impregnated bednets were observed to reduce absenteeism due to ill-health. NIBP was an efficient malaria control method in rural Gambia and saved resources.