The cost and cost-effectiveness of malaria vector control by residual insecticide house-spraying in Southern Mozambique: a rural and urban analysis
This paper compares two separately funded, but operationally similar, residual household spraying initiatives; one rural and one peri-urban in Southern Mozambique. It is the first costing exercise to compare and contrast urban and peri-urban settings, and one of only a handful of studies that has used detailed costing information to investigate such a large initiative.
Methods: The rural programme is a regional project involving the participation and co-ordination of organisations across three countries in Southern Africa and is focussed on control in an area in Mozambique of 7552 square kilometres. The second programme focuses on spraying a peri-urban community within a 10 kilometre radius around MOZAL, an aluminium smelter plant, area 410 square kilometers. An ingredients approach was used to derive unit costs for both the rural and peri-urban spraying programmes using detail retrospective cost data and effectiveness indicators.
Results: The economic cost per person covered per year using Carbamates for indoor residual spraying IRS) in the rural area, excluding the costs of project management and monitoring and surveillance was $3.48 and in the peri-urban area $2.16. The financial costs per person covered in the rural area and peri-urban area per year were $3.86 and $2.41 respectively. The economic costs per person covered were respectively increased by 39% and 31% when project management and monitoring and surveillance were included. The main driving forces behind the costs of delivering residual household spraying are twofold; the population covered and insecticide used. Computed economic and financial costs are presented for all four insecticide families available for use in RHS.
Conclusions: The results from both these initiatives, especially the rural area, should be interpreted as conservative cost estimates as they exclude the additional health gains that the newly introduced programmes have had on malaria rates in the neighbouring areas of South Africa and Swaziland. Both these initiatives show that introducing an IRS programme can deliver a reduction in malaria related suffering providing financial support, political will, collaborative management and training and community involvement are in place.
Tropical Medicine and International Health (2004) 9 (1) 125-132 [doi: 10.1046/j.1365-3156.2003.01150.x]