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dc.contributor.authorPhiri, Mphatso Dennis
dc.contributor.authorMcCann, Robert S
dc.contributor.authorKabaghe, Alinune Nathanael
dc.contributor.authorvan den Berg, Henk
dc.contributor.authorMalenga, Tumaini
dc.contributor.authorGowelo, Steven
dc.contributor.authorTizifa, Tinashe
dc.contributor.authorTakken, Willem
dc.contributor.authorvan Vugt, Michèle
dc.contributor.authorPhiri, Kamija S
dc.contributor.authorTerlouw, Dianne J
dc.contributor.authorWorrall, Eve
dc.date.accessioned2021-06-17T13:28:55Z
dc.date.available2021-06-17T13:28:55Z
dc.date.issued2021-06-13
dc.identifier.urihttp://hdl.handle.net/10713/16040
dc.description.abstractBackground: House improvement (HI) to prevent mosquito house entry, and larval source management (LSM) targeting aquatic mosquito stages to prevent development into adult forms, are promising complementary interventions to current malaria vector control strategies. Lack of evidence on costs and cost-effectiveness of community-led implementation of HI and LSM has hindered wide-scale adoption. This study presents an incremental cost analysis of community-led implementation of HI and LSM, in a cluster-randomized, factorial design trial, in addition to standard national malaria control interventions in a rural area (25,000 people), in southern Malawi. Methods: In the trial, LSM comprised draining, filling, and Bacillus thuringiensis israelensis-based larviciding, while house improvement (henceforth HI) involved closing of eaves and gaps on walls, screening windows/ventilation spaces with wire mesh, and doorway modifications. Communities implemented all interventions. Costs were estimated retrospectively using the 'ingredients approach', combining 'bottom-up' and 'top-down approaches', from the societal perspective. To estimate the cost of independently implementing each intervention arm, resources shared between trial arms (e.g. overheads) were allocated to each consuming arm using proxies developed based on share of resource input quantities consumed. Incremental implementation costs (in 2017 US$) are presented for HI-only, LSM-only and HI + LSM arms. In sensitivity analyses, the effect of varying costs of important inputs on estimated costs was explored. Results: The total economic programme costs of community-led HI and LSM implementation was $626,152. Incremental economic implementation costs of HI, LSM and HI + LSM were estimated as $27.04, $25.06 and $33.44, per person per year, respectively. Project staff, transport and labour costs, but not larvicide or screening material, were the major cost drivers across all interventions. Costs were sensitive to changes in staff costs and population covered. Conclusions: In the trial, the incremental economic costs of community-led HI and LSM implementation were high compared to previous house improvement and LSM studies. Several factors, including intervention design, year-round LSM implementation and low human population density could explain the high costs. The factorial trial design necessitated use of proxies to allocate costs shared between trial arms, which limits generalizability where different designs are used. Nevertheless, costs may inform planners of similar intervention packages where cost-effectiveness is known. Trial registration Not applicable. The original trial was registered with The Pan African Clinical Trials Registry on 3 March 2016, trial number PACTR201604001501493.en_US
dc.description.urihttps://doi.org/10.1186/s12936-021-03800-4en_US
dc.language.isoenen_US
dc.publisherSpringer Natureen_US
dc.relation.ispartofMalaria Journalen_US
dc.subjectCommunity-leden_US
dc.subjectCost analysisen_US
dc.subjectHouse improvementen_US
dc.subjectLarval source managementen_US
dc.subjectMalariaen_US
dc.titleCost of community-led larval source management and house improvement for malaria control: a cost analysis within a cluster-randomized trial in a rural district in Malawien_US
dc.typeArticleen_US
dc.identifier.doi10.1186/s12936-021-03800-4
dc.identifier.pmid34120608
dc.source.volume20
dc.source.issue1
dc.source.beginpage268
dc.source.endpage
dc.source.countryUnited Kingdom
dc.source.countryEngland


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