Seasonal malaria chemoprevention in northern Mozambique: A cost-effectiveness analysis

Authors: Neide Canana, Ivan Alejandro Pulido Tarquino, Sónia Enosse, Kevin Baker, Maria Rodrigues, Christian Rassi, Akashdeep Singh Chauhan, Chuks Nnaji, Baltazar Candrinho, Elisa M Maffioli

This study provides evidence for the cost-effectiveness of protecting under-fives with seasonal malaria chemoprevention (SMC) in an area of seasonal malaria transmission outside of the Sahel region, where it was first implemented.

Background
Malaria is endemic in Mozambique and one of the leading causes of death in children under five years old. In 2020, the country adopted the WHO-recommended seasonal malaria chemoprevention (SMC) strategy and delivered the intervention in all 23 districts of Nampula province between January and April 2023. The aim of this study is to estimate the cost-effectiveness of SMC in Nampula, Mozambique.

Methods
Financial costs of implementing SMC were estimated from a limited healthcare provider perspective for the year 2023 in US$. Data on resource use of the SMC implementation was assessed from Malaria Consortium records. The number of eligible and treated children was collected from surveys after cycle 4. The number of malaria cases, deaths and disability-adjusted life-years (DALYs) averted were estimated based on data from the Global Burden of Disease 2019, the Malaria Indicator Survey 2018 and the National Malaria Control Programme. Incremental cost-effectiveness ratios (ICERs) were estimated, and sensitivity analyses were used to test the robustness of the ICERs.

Results
The total financial cost of SMC implementation in Nampula province in 2023 was estimated to be $7,871,361.72. The study estimated a cost per targeted child of $6.05 and a cost per child who received full three-day course of sulfadoxine-pyrimethamine in combination with amodiaquine (SPAQ) of $7.92. Furthermore, the cost per household with eligible children visited by a community distributor was $7.65; the cost per child who received day 1 SPAQ was $7.85 and the cost per child who received day 1 SPAQ by community distributor adhering to directly observed treatment was $8.50. In addition, the estimated cost was $93.50 per malaria case averted, $3286.59 per malaria death averted, and $130.16 per DALY averted. The ICERs were robust to a variety of alternative assumptions on costs and benefit estimates. Finally, $1,726,189.63 could have been saved if no ineligible children (60–119 months old) were treated through the programme.

Conclusion
In line with existing evidence from other African countries, SMC is found to be cost-effective in Mozambique. SMC is a beneficial prevention strategy to improve under-five health in the country, at a relatively low-cost.

Published in Malaria Journal

Citation: Malaria Journal, 2025; 24(159).