Economic burden of malaria in children under the age of five in Burundi.

BACKGROUND: Although malaria is the leading killer of children under the age of five in Burundi, limited evidence on the associated costs are available. This study estimates the cost per malaria episode from the household, health system, and societal perspectives for children under the age of five in Burundi. METHODS: A micro-costing approach was used to estimate the cost per episode at community, primary, secondary and tertiary levels of the healthcare system at 15 sites across all five geographic regions in Burundi. Household costs were collected through interviews with caregivers using a structured questionnaire, while health system costs were determined by review of patient medical and financial records. RESULTS: The average societal cost per episode was US$12.1. Households shouldered most of these costs, with US$3.3 in out-of-pocket costs and US$4.7 in productivity losses due to the need for eight days of caregiving. Mean health system costs were US$2.6 for an outpatient visit and US$44.0 for inpatient treatment. The cost differed significantly across health system levels ranging from US$1.0 in the community-based programme to US$11.0 for a regional hospital outpatient visit, and from US$42.8-50.8 for inpatient stays. CONCLUSION: Malaria management imposes a substantial economic burden on households and the health system, particularly when requiring hospital admission. The household costs for a single malaria episode were equivalent to 44% of an individual's income for a month, while the health system costs per episode were nearly half the current government health expenditure per capita. Considering that some children will have multiple episodes per year, these are substantial costs. Further investment in preventive strategies and the introduction of new interventions, such as vaccines, could release government health resources for other diseases while enabling economic growth for households.