A cost analysis of the diagnosis and treatment of malaria at public health facilities and communities in three districts in Rwanda

Table 1 Malaria diagnosis and treatment services provided across public health facilities in Rwanda

	Home-based management	Health centre	District hospital
SM^a
Diagnosis	RDT^d	Consultation (nurse) Blood smear and/or RDT^d	Consultation (GP^k) Blood smear Complementary lab exam (CBC^l)
Treatment (first line)	ACT^e	ACT^e Supportive treatment^f (antipyretics)	ACT^e Supportive treatment^f (antipyretics)
SMD^b
Diagnosis	N/A	Consultation (nurse) Blood smear and/or RDT^d Complementary lab exam (Haemoglobin)	Consultation (GP^k) Blood smear Complementary lab exam (CBC^l)
Treatment (first line)	N/A	Hospitalization^g (LOS:2)^h Artesunate & Supportive treatment^f (antipyretics, ORSⁱ, IV^j fluids) ACT^e on discharge	Hospitalization^g (LOS:2)^h Medical visit in hospitalization Artesunate Supportive treatment^f (antipyretics, IV^j fluids) ACT^e on discharge
SVM^c
Diagnosis	N/A	Consultation by a nurse before transfer	Consultation (GP^k) Blood smear Complementary lab exam (CBC^l, blood glucose test, urea, creatinine)
Treatment (first line)	N/A	–	Hospitalization^g (LOS:5)^h Medical visit by (GP^k) Artesunate & ACT^e on discharge If cerebral form (added treatment): Anticonvulsants, antipyretics, antibiotics IV^j fluids and medical supplies (e.g., NGⁿ tube, Foley catheter)

^a SM: Simple Malaria; ^bSMD: Simple Malaria with Minor Digestive Symptoms; ^cSVM: Severe Malaria; ^dRDT: Rapid Diagnostic Test; ^eACT: Artemisinin-based combination therapy; ^f Supportive treatment: treatment given to relieve symptoms or prevent further complications; ^gHospitalization: cost of in-patient stay per day; ^hLOS: Length of in-hospital stay in days; ⁱORS: Oral Rehydration Salt; ^jIV: Intravenous, ^kGP: General Practitioner; ^lCBC: Complete Blood Count; ⁿNG: Nasogastric

ISSN: 1475-2875