Economic costs of epidemic malaria to households in rural Ethiopia

OBJECTIVE: To estimate the direct and indirect costs of malaria morbidity among communities in an epidemic area in rural Southcentral Ethiopia. METHODS: Community-based cross-sectional study of 2195 households in Adami Tulu district from October to November 2003. Treatment-seeking behaviour, expenditure on treatment and transportation, interruption of normal activities, time lost from working and household expenditure on preventive methods were ascertained through interview. RESULTS: Of 12,225 surveyed individuals, 1748 (14.3%) reported perceived malaria during the preceding 2 weeks. 77.1% sought any form of care and 70% had recovered at the time of interview. The average treatment cost per patient at private clinics was Birr 24.00 ($2.76) and Birr 12.50 ($1.44) at public facilities. The average estimated direct cost of malaria per patient was Birr 14.00 ($1.60); the average indirect cost, Birr 35.26 ($4.08). Only 5% of all households reported any preventive expenditure in the preceding month, with a mean of Birr 0.76 ($0.09). CONCLUSION: Malaria poses a significant economic burden on rural households and individuals both through out-of-pocket payment and person-days lost. The promotion and implementation of insecticide-treated nets would alleviate the economic consequences of the disease.