Durchimpfung und Prävalenz von IgG-Antikörpern gegen Masern bei Kindern und Jugendlichen in Deutschland

Background

Measles is a vaccine-preventable disease that could be eliminated by global vaccination strategies with two-dose measles vaccination. The World Health Organization (WHO) European Region aims at achieving measles elimination by 2015. Target control is mainly based on verification of 95?% vaccination coverage. In Germany, target verification cannot be based on data from centrally collected registers on vaccination and seroprevalence of measles-specific antibodies.

Objective

This paper provides an overview of measles vaccination coverage and the timeliness of measles vaccination in birth cohorts 1989–2008. In addition, factors associated with vaccination gaps are described.

Methods

Primary data on vaccination coverage (annual school entrance health examination) and on vaccination coverage and immune status (population-based German Health Interview and Examination Survey for Children and Adolescents – KiGGS) and secondary data (insurance refund claim data) are described and discussed.

Results and conclusion

The measles immunization coverage (two doses) obtained in the 2010 school entrance examinations was 91.5?%. The range was 87.6–95.3?% between Federal States. Regional differences were even more pronounced between districts. The timeliness of the two-dose measles immunization increased from 41?% (birth cohorts 2001/2002) to 66?% (birth cohorts 2006/2008). Despite progress in recent years, measles vaccination coverage is still inadequate in adolescents, young adults, and young children. The German Standing Committee on Vaccination (STIKO) recommends a combined MMR vaccination of adults who were born after 1970 and who were not fully vaccinated against measles during childhood. Successful implementation of this recommendation is crucial just as it is important to step up efforts to improve the timeliness of measles vaccination in young children. Regional vaccination gaps and susceptible clusters defined by age or sociodemographic parameters are of particular importance to the epidemiology of measles disease. Knowledge of the factors associated with nonimmunization should be used to tailor vaccination strategies.     

HPV vaccination coverage within 3?years of program launching (2008–2011) at Geneva State, Switzerland

Objective

The objective of this study is to assess the HPV vaccination coverage of 11?C19-year-old girls during a state-coordinated HPV vaccination program in Geneva, Switzerland, from September 2008 to June 2011.

Methods

State Medical Office coordinated the HPV vaccination program. Each service provider transmitted the list of the persons who had received their first, second, or third shot.

Results

The global coverage rates, 3?years after the program had been launched, were 63.72% for one dose, 63.22% for two doses, and 61.40% for three doses of the HPV vaccine.

Conclusion

This study shows that it is possible to obtain a good coverage rates after 3?years of a state-coordinated HPV vaccination program.     

Monitoring the performance of the Expanded Program on Immunization: the case of Burkina Faso

Background

The greatest challenge facing expanded programs on immunization in general, and in Burkina Faso in particular, lies in their capacity to achieve and sustain levels of immunization coverage that will ensure effective protection of children. This article aims to demonstrate that full immunization coverage of children, which is the primary indicator for monitoring national immunization programs, is sufficient neither to evaluate their performance adequately, nor to help identify the broad strategies that must be implemented to improve their performance. Other dimensions of performance, notably adherence to the vaccination schedule and the efficacy of the approaches used to reach all the children (targeting) must also be considered.

Methods

The study was carried out using data from surveys carried out in Burkina Faso: the 1993, 1998 and 2003 Demographic and Health Surveys and the 2003 national Survey of Immunization Coverage. Essentially, we described levels of immunization coverage and their trends according to the indicators considered. Performance differences are illustrated by amplitudes and maximum/minimum ratios.

Results

The health regions' performances vary according to whether they are evaluated on the basis of full immunization coverage or vaccination status of children who have not completed their vaccinations. The health regions encompass a variety of realities, and efforts of substantially different intensity would be required to reach all the target populations.

Conclusion

Decision-making can be improved by integrating a tripartite view of performance that includes full immunization coverage, adherence to the vaccination schedule (timely coverage), and the status of children who are not fully vaccinated. With such an approach, interventions can be better targeted. It provides information on the quality and timeliness of vaccination and identifies the efforts required to meet the objectives of full immunization coverage.

Abstract in French

See the full article online for a translation of this abstract in French.

     

Bevölkerungswirksamkeit von Prävention

Background

The costs of preventive measures are quantifiable and comparable. There are no easily understandable, simple and comparable models to calculate the impact of prevention on the whole population.

Aims

The paper describes a model to calculate the population impact (PI) of preventive measure and applies this to prevention of tobacco-attributable diseases. It theoretically deducts four parameters necessary for calculation: reach, participation, efficacy of an intervention and frequency of health risk.

Results

It is shown that proactive and reactive prevention measures differ substantially in achieving population impact. It is discussed that PI can be a benchmark for comparison of population-based measures and a standardised part of cost-effectivity analyses. Applying the PI is dependent on careful consideration of a variety of factors and adequate application is impossible without studies providing the necessary parameters. In Germany this is the common case in most population-based measures. This needs to be changed.     

Proximity of public elementary schools to major roads in Canadian urban areas

Objective

The objective of this study is to examine the relationship between residential exposure to fast-food entrées, using two measures of potential spatial access: proximity (distance to the nearest location) and coverage (number of different locations), and weekly consumption of fast-food meals.

Methods

Traditional fast-food restaurants and non-traditional fast-food outlets, such as convenience stores, supermarkets, and grocery stores, from the 2006 Brazos Valley Food Environment Project were linked with individual participants (n = 1409) who completed the nutrition module in the 2006 Brazos Valley Community Health Assessment.

Results

Increased age, poverty, increased distance to the nearest fast food, and increased number of different traditional fast-food restaurants, non-traditional fast-food outlets, or fast-food opportunities were associated with less frequent weekly consumption of fast-food meals. The interaction of gender and proximity (distance) or coverage (number) indicated that the association of proximity to or coverage of fast-food locations on fast-food consumption was greater among women and opposite of independent effects.

Conclusions

Results provide impetus for identifying and understanding the complex relationship between access to all fast-food opportunities, rather than to traditional fast-food restaurants alone, and fast-food consumption. The results indicate the importance of further examining the complex interaction of gender and distance in rural areas and particularly in fast-food consumption. Furthermore, this study emphasizes the need for health promotion and policy efforts to consider all sources of fast-food as part of promoting healthful food choices.     

Patterns of pre-treatment drug abuse, drug treatment history and characteristics of addicts in methadone maintenance treatment in Iran

Background

Opiates are the main drugs of abuse, and Methadone Maintenance Treatment (MMT) is the most widely administered drug addiction treatment program in Iran. Our study aimed to investigate patterns of pre-treatment drug abuse, addiction treatment history and characteristics of patients in MMT in Tehran.

Methods

We applied a stratified cluster random sampling technique and conducted a cross-sectional survey utilizing a standard patient characteristic and addiction history form with patients (n?=?810) in MMT. The Chi-square test and t-test served for statistical analyses.

Results

A clear majority of the participants were men (96%), more than 60% of whom were between 25 and 44?years of age, educated (89% had more than elementary education), and employed (>70%). The most commonly reported main drugs of abuse prior to MMT entry were opium (69%) and crystalline heroin (24%). The patients?? lifetime drug experience included opium (92%), crystalline heroin (28%), cannabis (16%), amphetamines (15%), and other drugs (33%). Crystalline heroin abusers were younger than opium users, had begun abusing drugs earlier, and reported a shorter history of opiate addiction.

Conclusion

Opium and crystalline heroin were the main drugs of abuse. A high rate of addiction using more dangerous opiate drugs such as crystalline heroin calls for more preventive efforts, especially among young men.     

Measles in 2010. Knowledge and vaccination status of medical students

Objectives

In 2002, the WHO Regional Office for Europe developed a strategic plan for measles in the WHO European Region. WHO recommends that at least 95% of children receive two doses of measles vaccine. This plan targeted the elimination of measles for the year 2010 and is supported by the Federal Republic of Germany.

Methods

Questionnaire survey, serological tests and check-up of the certificates of vaccination were offered to second year medical students of Goethe University Frankfurt/Main, Germany.

Results

Only 62.3% of medical students had received two doses of measles vaccine. Serological data showed that 23.1% were not immune against measles. Important gaps of knowledge were identified in the knowledge test of the survey; less than one third of the students (n=95/324) were able to answer more than 50% of the questions correctly.

Discussion

The suboptimum measles-vaccination coverage shows that the goal of eliminating measles will not be met across Europe by the target year 2010. Both occupational and public health measures need to make sure that vaccination programs should achieve a minimum of 95% coverage with two doses. In addition, the obligation to notify the authorities even of suspected cases serve the same purpose and measures to improve the knowledge of medical students are required. Consequent surveillance systems are necessary to investigate chains of measles infections. Healthcare workers play a decisive role in this issue.     

Understanding consumer preferences in the context of managed competition

Background

In many countries, health insurance coverage is the primary way for individuals to access care. Governments can support access through social insurance programmes; however, after a certain period, governments struggle to achieve universal coverage. Evidence suggests that complex individual behaviour may play a role.

Objectives

Using a choice experiment, this research explored consumer preferences for health insurance in Colombia. We also evaluated whether preferences differed across consumers with differing demographic and health status factors.

Methods

A household field experiment was conducted in Bogotá in 2010. The sample consisted of 109 uninsured and 133 low-income insured individuals. Each individual evaluated 12 pair-wise comparisons of hypothetical health plans. We focused on six characteristics of health insurance: premium, out-of-pocket expenditure, chronic condition coverage, quality of care, family coverage and sick leave. A main effects orthogonal design was used to derive the 72 scenarios used in the choice experiment. Parameters were estimated using conditional logit models. Since price data were included, we estimated respondents?? willingness to pay for characteristics.

Results

Consumers valued health benefits and family coverage more than other attributes. Additionally, differences in preferences can be exploited to increase coverage. The willingness to pay for benefits may partially cover the average cost of providing them.

Conclusion

Policy makers might be able to encourage those insured via the subsidized system to enrol in the next level of the social health insurance scheme through expanding benefits to family members and expanding the level of chronic condition coverage.     

Information systems on human resources for health: a global review

Background

Although access to life-saving treatment for patients infected with HIV in South Africa has improved substantially since 2004, treating all eligible patients (universal access) remains elusive. As the prices of antiretroviral drugs have dropped over the past years, availability of human resources may now be the most important barrier to achieving universal access to HIV treatment in Africa. We quantify the number of HIV health workers (HHWs) required to be added to the current HIV workforce to achieve universal access to HIV treatment in South Africa, under different eligibility criteria.

Methods

We performed a time and motion study in three HIV clinics in a rural, primary care-based HIV treatment program in KwaZulu-Natal, South Africa, to estimate the average time per patient visit for doctors, nurses, and counselors. We estimated the additional number of HHWs needed to achieve universal access to HIV treatment within one year.

Results

For universal access to HIV treatment for all patients with a CD4 cell count of ≤350 cells/μl, an additional 2,200 nurses, 3,800 counselors, and 300 doctors would be required, at additional annual salary cost of 929 million South African rand (ZAR), equivalent to US$ 141 million. For universal treatment (‘treatment as prevention’), an additional 6,000 nurses, 11,000 counselors, and 800 doctors would be required, at an additional annual salary cost of ZAR 2.6 billion (US$ 400 million).

Conclusions

Universal access to HIV treatment for patients with a CD4 cell count of ≤350 cells/μl in South Africa may be affordable, but the number of HHWs available for HIV treatment will need to be substantially increased. Treatment as prevention strategies will require considerable additional financial and human resources commitments.     

Does extending health insurance coverage to the uninsured improve population health outcomes?

Background

An ongoing debate exists about whether the US should adopt a universal health insurance programme. Much of the debate has focused on programme implementation and cost, with relatively little attention to benefits for social welfare.

Objective

To estimate the effect on US population health outcomes, measured by mortality, of extending private health insurance to the uninsured, and to obtain a rough estimate of the aggregate economic benefits of extending insurance coverage to the uninsured.

Method

We use state-level panel data for all 50 states for the period 1990–2000 to estimate a health insurance augmented, aggregate health production function for the US. An instrumental variables fixed-effects estimator is used to account for confounding variables and reverse causation from health status to insurance coverage. Several observed factors, such as income, education, unemployment, cigarette and alcohol consumption and population demographic characteristics are included to control for potential confounding variables that vary across both states and time.

Results

The results indicate a negative relationship between private insurance and mortality, thus suggesting that extending insurance to the uninsured population would result in an improvement in population health outcomes. The estimate of the marginal effect of insurance coverage indicates that a 10% increase in the population-insured rate of a state reduces mortality by 1.69–1.92%. Using data for the year 2003, we calculate that extending private insurance coverage to the entire uninsured population in the US would save over 75 000 lives annually and may yield annual net benefits to the nation in excess of $US400 billion.

Conclusion

This analysis suggests that extending health insurance coverage through the private market to the 46 million Americans without health insurance may well produce large social economic benefits for the nation as a whole.     

Use of fake identification to purchase alcohol amongst 15-16 year olds: a cross-sectional survey examining alcohol access,consumption and harm

Objectives

Injection drug users (IDUs) are at high risk for HIV, hepatitis, overdose and other harms. Greater drug treatment availability has been shown to reduce these harms among IDUs. Yet, little is known about changes in drug treatment availability for IDUs in the U.S. This paper investigates change in drug treatment coverage for IDUs in 90 metropolitan statistical areas (MSAs) during 1993-2002.

Methods

We define treatment coverage as the percent of IDUs who are in treatment. The number of IDUs in drug treatment is calculated from treatment entry data and treatment census data acquired from the Substance Abuse and Mental Health Service Administration, divided by our estimated number of IDUs in each MSA.

Results

Treatment coverage was low in 1993 (mean 6.7%; median 6.0%) and only increased to a mean of 8.3% and median of 8.0% coverage in 2002.

Conclusions

Although some MSAs experienced increases in treatment coverage over time, overall levels of coverage were low. The persistence of low drug treatment coverage for IDUs represents a failure by the U.S. health care system to prevent avoidable harms and unnecessary deaths in this population. Policy makers should expand drug treatment for IDUs to reduce blood-borne infections and community harms associated with untreated injection drug use.     

An application of a proposed framework for formulary listing in low-income countries

Background

The General Mutual Benefit Fund for Civil Servants and State Employees of Côte d’Ivoire (MUGEFCI; Mutuelle Générale des Fonctionnaires et Agents de l’État de Côte d’Ivoire) is a health mutual fund providing coverage (medical consultations, laboratory tests and treatment) for its enrolees (government officials and agents). This organization aims to improve its current drug reimbursement process because of budgetary constraints. One method of achieving this is to implement a formulary-listing framework specifically developed for low-income countries.

Objective

The aim of this study was to evaluate the feasibility of developing a new formulary for the MUGEFCI in Côte d’Ivoire, by implementing a formulary-listing framework specifically designed for under-researched settings.

Methods

The application of this formulary-listing framework (based on multi-criteria decision analysis [MCDA]) consisted of four steps. First, relevant formulary-listing criteria and their levels of variation were identified and weighted according to their importance in the decision making around drug reimbursement. Second, a set of priority treatments to be assessed was determined. Once the treatments eligible for reimbursement were determined, scores were assigned to these treatments according to their performance on the formulary-listing criteria levels. Finally, a composite league table (weighted matrix) was constructed to rank the set of treatments by priority order of reimbursement. A budget-impact analysis (BIA) was also conducted to appraise the economic implications of the new composite drugs league table. The extent to which the new priority list of reimbursable drugs was affordable for the MUGEFCI was then measured.

Results

Policy makers in Côte d’Ivoire considered severity of disease and cost effectiveness of treatment to be the most significant criteria for priority reimbursement of drugs. This translated into a general preference for antimalarials, treatments for asthma and antibacterials for urinary tract infection. Moreover, the results of the BIA suggest that the new priority list of reimbursable drugs would be affordable if the real economic impact of drugs per member is less than $US66. Over this threshold, the MUGEFCI would have to select reimbursable drugs according to their rank in the priority list and their respective budget impact per patient (cost per patient). This selection would start from the first treatment, going down the list until the $US66 per patient is exhausted.

Conclusion

It was possible to use MCDA to simultaneously consider different decision criteria for drug reimbursement in Côte d’Ivoire; therefore, it is feasible to use MCDA to establish a formulary for low-income countries. The application of this method is a step towards transparency in policy making.     

AIDS-Prävention mit sozial benachteiligten Kindern in der Republik Südafrika

Background

Approximately two-thirds of the worldwide population infected with the human immunodeficiency virus (HIV) are currently living in the sub-Saharan region. The need for increased prevention is not controversial, but preventive efforts are undertaken mainly in relation to adolescents and adults.

Target group and methods

This study deals with a life-skills programme on HIV/AIDS for socially disadvantaged children of primary school age in an informal settlement of the Stellenbosch municipal area in the Western Cape province of the Republic of South Africa. The programme was outlined and evaluated using a questionnaire within a quasi-experimental design with an intervention and a control group and four measuring time points each.

Results

For the children in the intervention group, the results indicate a significant increase in knowledge about HIV and AIDS between the pretest and the posttest. In the subsequent measurements, however, the knowledge values decreased back to the initial level.

Conclusion

The reasons for this lack of sustainability are discussed with regard to the children’s unique socioeconomic and sociocultural life situation. Perspectives for further prevention efforts can be derived.     

Diagnosis and treatment of risk factors in Germany and the UK

Objective

To estimate the impact of different systems of family practitioners’ payment on process of care: fee-for-service vs. capitation.

Design

Cross sectional international survey using cardiovascular prevention as an indicator of the quality of care.

Setting

Family physicians’ practices in Germany (fee-for-service) and the UK (capitation).

Subjects

778 patients attending for consultation regardless of morbidity or risk factor status.

Main outcome measures

Intervals since last consultation, since last BP-measurement, prevalence of known hypertension.

Results

There is a higher overall level of activity under FFS, but under capitation FPs seem to concentrate their efforts on the more severely ill or at risk. This would explain that under different systems of remuneraton the quality of care (outcome) is usually similar.

Conclusions

In areas of uncertainty FFS seems to stimulate activity or intervention, whereas under capitation FPs are rather reluctant to engage in procedures or interventions that are not sufficiently evaluated. Under prepaid remuneration FPs adjust in a way that the quality of care does not suffer.     

Social contact networks for the spread of pandemic influenza in children and teenagers

Background

There is evidence that poverty, health and nutrition affect children's cognitive development. This study aimed to examine the relative contributions of both proximal and distal risk factors on child cognitive development, by breaking down the possible causal pathways through which poverty affects cognition.

Methods

This cohort study collected data on family socioeconomic status, household and neighbourhood environmental conditions, child health and nutritional status, psychosocial stimulation and nursery school attendance. The effect of these on Wechsler Pre-School and Primary Scale of Intelligence scores at five years of age was investigated using a multivariable hierarchical analysis, guided by the proposed conceptual framework.

Results

Unfavourable socioeconomic conditions, poorly educated mother, absent father, poor sanitary conditions at home and in the neighbourhood and low birth weight were negatively associated with cognitive performance at five years of age, while strong positive associations were found with high levels of domestic stimulation and nursery school attendance.

Conclusion

Children's cognitive development in urban contexts in developing countries could be substantially increased by interventions promoting early psychosocial stimulation and preschool experience, together with efforts to prevent low birth weight and promote adequate nutritional status.     

Quo vadis Germania? Die Nationale Kommission zur Verifizierung der Elimination der Masern und Röteln

Background

Since 1984, the World Health Organization (WHO) European Region has pursued the goal of eliminating measles. In 2005, it was decided to also stop the endemic transmission of rubellavirus, thereby eliminating congenital rubella syndrome. Both infections are to be eliminated by 2015. To document the progress and verify the elimination at country level, national verification committees should be established in WHO EU memberstates.

Procedure

In December 2012, the German Ministry of Health appointed the German National Verification Committee for Measles and Rubella Elimination. The commission meets at least twice a year to compile and analyze data on the epidemiology of measles and rubella in Germany and on the vaccination coverage/ immunity of the German population against these infections to assess progress in the elimination goals. Furthermore, the commission indicates whether the available data are sufficient or contain inconsistencies, evaluates the success of key strategies implemented, and advises on activities related to the verification of the elimination process in the country. A scientific report on the commission’s findings is to be submitted annually to the WHO regional office.

Future prospects

Germany is committed to the aim of eliminating measles and rubella. Thus, every possible effort should be made to reach this goal by the responsible players in the German immunization system. The commission – as an independent group of experts – will critically accompany and evaluate this process.     

Status of multidrug resistance in tubercle bacillus and phytochemicals for the control

Aim

The purpose of this study is to present the possibility of the control of the appalling tubercle bacillus (TB) strains of the present time with pure phytochemicals as a complementary or palpable source of drugs.

Present problem

Multidrug resistant (MDR) strains of TB for the current first-line drugs have emerged independently in several countries. The second-line or the reserve-line drugs are less often used for more side effects.

Possibility

Extracts and pure phytochemicals of several plants are reported from many laboratories to have control over TB in vitro, which indicated that phytochemicals could be the suitable complementary candidates in the control of the range of MDR-TB strains, along with an ongoing treatment regimen. Extracts from plants, Lantana hispida, Eremophila, Galenia africana, Dodonea angustifolia, Bridelia micrantha, Achyrocline alata and Swinglea glutinosa, specifically phytochemicals, 5,7,2′-trihydroxyflavone, carvacrol, thymol, p-cymene, 1,8-cineole and limonene have been reported to have promising antitubercular activity in vitro. Pure phytochemicals should have the coveted credibility as complementary medicines and those could lend themselves for further manipulation before the use against TB.

Conclusion

Some avant-garde drug is the need of the day for TB, and pure phytochemicals could be considered.     

Zwischen Wunsch und Wirklichkeit: Die langfristige Umsetzung schulbasierter Präventionsprogramme in der Praxis am Beispiel Klasse2000

Background

With increasing dissemination of school-based prevention programs, prevention research faces new challenges. Several programs in Germany have evaluated their effects on substance abuse and violence. However, the question arises whether in wide-scale dissemination high-quality implementation can be maintained.

Methods

The aim of this paper is to assess the fidelity of implementation of Klasse2000, the most widely disseminated prevention program for elementary schools in Germany and to identify factors that influence the amount of coverage. For this purpose, we analyzed teachers’ self-reports in four years.

Results

The results show that program implementation was continuously sufficient with best coverage in the 1st and the 4th years. Teachers’ attitudes towards the program and experience with the complete Klasse2000 curriculum influence implementation.

Conclusion

We conclude that for a high-fidelity long-term implementation, additional reinforcement is required as well as continuous evaluation and adaptation to meet the needs of the practitioners.     

Dental health in the United Kingdom and influencing variables

Objective

To review four key topics pertaining to the oral health of the United Kingdom (UK): (1) provision of state-funded dentistry, (2) trends in oral health, (3) dental caries prevention, and (4) determinants of dental health.

Methods

Data were abstracted, mainly from peer-reviewed publications in the literature. Information was updated where appropriate.

Results

Since the 1948 inception of the National Health Service (NHS) and its General Dental Service (GDS), the system of providing dentistry has evolved in response to changing fiscal and health circumstances. Since the 1970s, the oral health of the population, both children??s dental decay experience and the decline adult tooth loss, has improved steadily and substantially. Approaches towards prevention are discussed and the dominant position of water fluoridation highlighted. The determinants of dental health are analysed.

Conclusion

Dental caries experience of children in the UK and the rest of Europe is highly correlated with national wealth as are two other significant determinants: fluoride toothpaste and sugar consumption. The activity of dental professionals appears to have only a limited influence on levels of oral health. There is reason to believe that UK water fluoridation coverage may broaden.     

Cost-effectiveness analysis of malaria interventions using disability adjusted life years: a systematic review

Background

Malaria continues to be a public health problem despite past and on-going control efforts. For sustenance of control efforts to achieve the malaria elimination goal, it is important that the most cost-effective interventions are employed. This paper reviews studies on cost-effectiveness of malaria interventions using disability-adjusted life years.

Methods

A review of literature was conducted through a literature search of international peer-reviewed journals as well as grey literature. Searches were conducted through Medline (PubMed), EMBASE and Google Scholar search engines. The searches included articles published in English for the period from 1996 to 2016. The inclusion criteria for the study were type of malaria intervention, year of publication and cost-effectiveness ratio in terms of cost per DALY averted. We included 40 studies which specifically used the DALY metric in cost-effectiveness analysis (CEA) of malaria interventions.

Results

The majority of the reviewed studies (75%) were done using data from African settings with the majority of the interventions (60.0%) targeting all age categories. Interventions included case treatment, prophylaxis, vector control, insecticide treated nets, early detection, environmental management, diagnosis and educational programmes. Sulfadoxine–pyrimethamine was the most common drug of choice in malaria prophylaxis, while artemisinin-based combination therapies were the most common drugs for case treatment. Based on guidelines for CEA, most interventions proved cost-effective in terms of cost per DALYs averted for each intervention.

Conclusion

The DALY metric is a useful tool for determining the cost-effectiveness of malaria interventions. This paper demonstrates the importance of CEA in informing decisions made by policy makers.