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Objective To compare the cost-effectiveness of conventional antimalarial therapy with that of three artemisinin combination treatment regimens in children from Papua New Guinea aged 6 to 60 months. Methods An incremental cost-effectiveness analysis was performed using data from 656 children with Plasmodium falciparum and/or P. vivaxmalaria who participated in a large intervention trial in two clinics in northern Papua New Guinea. The children were randomized to one of the following groups: (i) conventional treatment with chloroquine plus sulfadoxine plus pyrimethamine (CQ+S+P); (ii) artesunate plus S plus P; (iii) dihydroartemisinin plus piperaquine (DHA+PQ); and (iv) artemether plus lumefantrine (A+L). For treatment outcomes, World Health Organization definitions were used. The cost of transport between home and the clinic plus direct health- care costs served as a basis for determining each regimen's incremental cost per incremental treatment success relative to CQ+S+P by day 42 and its cost per life year saved. Findings A+L proved to be the most effective regimen against R falciparum malaria and was highly cost-effective at 6.97 United States dollars (USS) per treatment success (about USS 58 per life year saved). DHA+PQ was the most effective regimen against P. vivax malaria and was more cost-effective than CQ+S+R Conclusion A+L and DHA+PQ are highly cost-effective regimens for the treatment of paediatric P. falciparum and R vivax malaria, respectively, in parts of Papua New Guinea. Future research will be required to determine if these findings hold true for other territories in Asia and Oceania with similar malaria epidemiology. Objectif Comparer le rapport cout -efficacite de la therapie antipaludeenne conventionnelle avec le rapport respectif de trois regimes de traitement associe a base d'artemisinine chez des enfants de Papouasie-NouvelleGuinee ages de 6 a 60 mois. Methodes Une analyse differentielle de cout-efficacite a ete realisee l'aide des donnees de 656 enfants souffrant de Plasmodium falciparum et/ ou de paludisme a P. vivax ayant participe a un vaste essai d'intervention sur le littoral nord-occidental de la Papouasie-Nouvelle-Guinee. Les enfants, qui ont ete presentes dans deux cliniques, ont fait I'objet d'une randomisation vers I'un des regimes therapeutiques suivants : (i) traitement conventionnel avec chloroquine et sulfadoxine-pyrimethamine; (ii) artesunate plus sulfadoxine-pyrimethamine; (iii) dihydroartemisininepiperaquine (DHA+PQ); et (iv) artemether-lumefantrine (A+L). Les resultats des traitements ont ete etablis conformement aux definitions standard de l'Organisation mondiale de la Sante. Le cout du transport entre le domicile et la clinique, ainsi que les frais directs lies aux soins de sante dispenses, ont ete calcules comme base determinante du cout differentiel de chaque regime par traitement reussi au jour 42, et son cout par annee de vie sauvee. Resultats A+L s'est revele comme le regime le plus efficace du point de vue clinique dans le traitement du paludisme a P. falciparum et representait un excellent rapport cout-efficacite a 6,97 dollars par traitement reussi (environ 58 dollars par annee de vie sauvee). DHA+PQ representait l'association de traitement la plus efficace dans la lutte contre le paludisme a P. vivax, et etait d'un meilleur rapport cout-efficacite que le traitement conventionnel contre le paludisme. Conclusion A+L et DHA+PQ sont des regimes tres rentables pour traiter, respectivement, le paludisme pediatrique a P. falciparum et a P vivax, dans les regions de la Papouasie-Nouvelle-Guinee. Des recherches futures seront necessaires arin de determiner si ces resultats se confirment dans d'autres territoires d'Asie et d'Oceanie presentant une epidemiologie de paludisme similaire. Objetivo Comparar la rentabilidad del tratamiento antipaludico convencional respecto a la de los tres tratamientos combinados con artemisinina en ninos de entre 6 y 60 meses de Papua Nueva Guinea. Metodos Se realizo un analisis incremental de la rentabilidad con los datos procedentes de 656 ninos con malaria por Plasmodium falciparum y/o por R vivax que participaron en un ensayo intervencionista a gran escala en la costa Norte de Papua Nueva Guinea. A los ninos que acudieron a dos consultorios, se les asigno aleatoriamente uno de los siguientes tratamientos: (a) tratamiento tradicional con cloroquina, sulfadoxina y pirimetamina; (b) artesunato, sulfadoxina y pirimetamina; (c) dihidroartemisinina y piperaquina (DHA+PQ); y (d) artemeter y lumefantrina (A+L). Se definieron los resultados terapeuticos siguiendo las definiciones normalizadas de la Organizacion Mundial de la Salud. Como base para la determinacion de los costes incrementales por cada logro terapeutico alcanzado a los 42 dias y su coste por ano de vida salvado, se calculo el coste del transporte entre el hogar y el centro de salud, junto con los gastos directos ocasionados por la asistencia sanitaria proporcionada. Resultados Desde el punto de vista clinico, el tratamiento mas eficaz contra la malaria por R falciparum fue el A+L, con una rentabilidad muy elevada de 6,97 dolares norteamericanos (USS) por logro terapeutico (unos 58 USS por ano de vida salvado). La combinacion terapeutica mas eficaz contra la malaria producida por R vivaxfue la DHA+PQ y resulto ser mas rentable que el tratamiento antipaludico habitual. Conclusion En algunas zonas de Papua Nueva Guinea, les tratamientos A+L y DHA+PQ resultan muy rentables en el tratamiento pediatrico contra la malaria por R falciparum y R vivax, respectivamente. Es preciso que se investigue mas en profundidad para determinar si estos resultados tambien son validos para otras regiones de Asia y Oceania que presenten una epidemiologia de malaria similar., Introduction Recent estimates show that Plasmodium falciparum causes 225 to 500 million cases of malaria and nearly one million malaria-related deaths worldwide each year. (1-3) Of these deaths, 96% take [...]

Abstract Background Malaria places a significant burden on the limited resources of many low income countries. Knowing more about why and where people seek treatment will enable policy makers to better allocate the limited resources. This study aims to better understand what influences treatment-seeking behaviour for malaria in one such low-income country context, Papua New Guinea (PNG). Methods Two culturally, linguistically and demographically different regions in PNG were selected as study sites. A cross sectional household survey was undertaken in both sites resulting in the collection of data on 928 individuals who reported suffering from malaria in the previous four weeks. A probit model was then used to identify the factors determining whether or not people sought treatment for presumptive malaria. Multinomial logit models also assisted in identifying the factors that determined where people sought treatments. Results Results in this study build upon findings from other studies. For example, while distance in PNG has previously been seen as the primary factor in influencing whether any sort of treatment will be sought, in this study cultural influences and whether it was the first, second or even third treatment for a particular episode of malaria were also important. In addition, although formal health care facilities were the most popular treatment sources, it was also found that traditional healers were a common choice. In turn, the reasons why participants chose a particular type of treatment differed according to the whether they were seeking an initial or subsequent treatments. Conclusions Simply bringing health services closer to where people live may not always result in a greater use of formal health care facilities. Policy makers in PNG need to consider within-country variation in treatment-seeking behaviour, the important role of traditional healers and also ensure that the community fully understands the potential implications of not seeking treatment for illnesses such as malaria at a formal health care facility.

As in 1984, Queen's University, Kingston, Ontario was the site for Conference '98 from 11 - 14 June, 1998. Two hundred people registered, with representation from 9 provinces and 28 [...]