There have been impressive gains in the fight against malaria since 2000, with incidence dropping nearly 30 percent globally and mortality falling by 47 percent, according to recent World Health Organization estimates. Evidence is scant, however, when it comes to understanding the broader impact of these gains on health systems in lower middle-income countries. In particular, as malaria incidence declines, to what extent are hospital beds, medical supplies, and other resources freed up to treat other diseases?                                                                             

An early adopter of malaria prevention, diagnosis, and treatment programs, Zambia has achieved impressive strides in controlling the disease. In collaboration with two Zambian hospitals, the HFG project completed two innovative studies to  better understand the impact of malaria interventions on the health system.

As expected, the research found that the scale-up of malaria prevention, diagnosis and treatment programs was associated with declines in malaria admissions. But the studies also found additional health system benefits:

• Cumulative cost savings of $340,000 over five years at one of the hospitals as malaria interventions were scaled-up (this amount is equivalent to a third of the hospital’s yearly expenditures); and
• Reduced use of blood transfusions in the pediatric ward as a result of fewer pediatric admissions for severe malarial anemia, a common complication of malaria.

Overall, the findings suggest the scale-up of these malaria prevention, diagnosis and treatment interventions free up facility-level resources, such as blood supplies and financial resources, which can be used for other patients.

Published in Malaria Journal, the first study “Association between malaria control and pediatric blood transfusions in rural Zambia: an interrupted time-series analysis,” investigates the association between the scale-up of malaria prevention, diagnosis and treatment interventions and the use of pediatric blood transfusions, which can reduce mortality among children with severe malarial anemia. The study drew on data from facility and patient records covering all pediatric malaria admissions from 2000 to 2008 at a referral hospital, Macha Mission Hospital, in rural Zambia.

The results showed that during the 2004-2006 malaria control scale-up period there was a 50 percent reduction in the use of pediatric blood transfusions relative to the previous period when malaria control was relatively limited. During the 2007-2008 period, use of pediatric blood transfusions fell by 72 percent compared to the period with limited malaria control. As a result of the reduction in the use of pediatric blood transfusions for malaria admissions, blood transfusions are potentially being freed up for other patients, particularly where blood supply is limited.

The second study, published in The American Journal of Tropical Medicine and Hygiene, reported a pre-post comparison of hospital admissions and outpatient visits for malaria, and estimated costs incurred for malaria admissions before and after malaria prevention, diagnosis and treatment programs were scaled-up. The study, “Hospitalizations and Costs Incurred at the Facility Level after Scale-up of Malaria Control: Pre-Post Comparisons from Two Hospitals in Zambia,” showed a substantial reduction in malaria admissions and a decrease in total hospital spending after malaria prevention, diagnosis and treatment interventions were scaled-up.

In one hospital, malaria accounted for 11 percent of total hospital spending before the scale-up of these malaria prevention, diagnosis and treatment interventions compared with less than one percent after the scale-up of these interventions. The findings suggest that as malaria prevention, diagnosis and treatment programs are scaled-up, facility-level resources become available for use for other health needs. In hospitals with scant resources, the decreased burden from malaria could also mean higher quality care for patients with other diseases and conditions.

Both studies were the result of a collaboration across several partners including the U.S. President’s Malaria Initiative, the Centers for Disease Control, Macha Mission Hospital, Livingstone General Hospital, and the HFG project. The Zambia Integrated Systems Strengthening Project also provided input.