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Table 3 The annual health and economic impact of malaria, substandard and falsified anti-malarials, and antimicrobial resistance, among children < 5 in Uganda

From: Development of an agent-based model to assess the impact of substandard and falsified anti-malarials: Uganda case study

 

Annual burden of malariaa

Annual burden of malaria among cases that sought treatmentb

Impact of substandard and falsified anti-malarialsd

Impact of antimicrobial resistancee

Baseline

95% CI

Baseline

95% CI

Impact

% Diffc

p-value

Potential Impact

% Diffc

p-value

Avg. # cases

3,528,304

(3,527,862–3528,747)

3,331,214

(3,330,797–3,331,632)

154

0%

0.62

− 841

0%

0.01*

Avg. # hospitalized

176,744

(175,095–178,393)

176,744

(175,095–178,393)

13,919

8%

< 0.01*

10,418

6%

< 0.01*

Avg. # with NS

10,924

(10,720–11,128)

5665

(5531–5798)

307

5%

0.11

259

5%

< 0.01*

Avg. # deaths

29,481

(29,089–29,874)

12,893

(12,668–13,117)

1121

9%

< 0.01*

884

7%

< 0.01*

DALYs

1,999,460

(1,968,489–2,030,430)

1,091,211

(1,074,943–1,107,478)

78,565

7%

< 0.01*

63,040

6%

< 0.01*

YLLs

1,733,368

(1,704,149–1,762,587)

953,001

(937,692–968,310)

71,113

7%

< 0.01*

56,681

6%

< 0.01*

Economic impact

$613,510,000

(605,555,098–621,465,371)

$402,945,000

(394,989,859–410,900,132)

$31,009,000

8%

< 0.01*

$48,455,000

12%

< 0.01*

Direct costs

$57,669,000

(57,550,551–57,787,308)

$57,669,000

(57,550,551–57,787,308)

$5,151,000

9%

< 0.01*

$15,539,000

27%

< 0.01*

Facility costs

$32,550,000

(32,469,063–32,631,682)

$32,550,000

(32,469,063–32,631,682)

$2,857,000

9%

< 0.01*

$8,013,000

25%

< 0.01*

Out-of-pocket costs

$25,119,000

(25,081,489–25,155,626)

$25,119,000

(25,081,489–25,155,626)

$2,294,000

9%

< 0.01*

$7,526,000

30%

< 0.01*

Productivity losses

$555,841,000

(547,706,922–563,975,688)

$345,276,000

(340,893,439–349,658,692)

$25,859,000

7%

< 0.01*

$32,916,000

10%

< 0.01*

Short-term

$88,273,000

(86,720,283–89,825,161)

$140,798,000

(129,970,519–151,626,292)

$8,083,000

6%

< 0.01*

$18,903,000

13%

< 0.01*

Disability

$47,952,000

(46,753,481–49,150,506)

$37,256,000

(36,329,319–38,182,459)

$2,019,000

5%

< 0.01*

$1,725,000

6%

< 0.01*

Death

$419,617,000

(411,128,280–428,104,899)

$167,222,000

(161,703,081–172,740,461)

$15,756,000

9%

< 0.01*

$12,287,000

7%

< 0.01*

  1. Avg # average number, CI confidence interval, DALYs disability-adjusted life years, Diff difference, NS neurological sequelae, YLLs years of life lost
  2. * p-value < 0.05
  3. a The annual burden of malaria is estimated among all children < 5 in Uganda, including those that did not seek or receive medical treatment
  4. b This includes cases that sought care who may not have received treatment due to stock out of anti-malarials
  5. c Estimates the difference compared to the annual burden of malaria among cases that sought treatment
  6. d The impact of substandard and falsified anti-malarials is already incorporated in the annual burden of malaria. This impact could be reduced by improving the quality of medicines so all anti-malarials have an API > 85%
  7. e This scenario demonstrates the additional potential impact of antimicrobial resistance if treatment effectiveness of ACTs and quinine were reduced to the level of other treatments