Economic and clinical burden of uncomplicated and severe malaria in children: real world evidence from Western Kenya

Background Malaria remains a major cause of morbidity among children in Kenya and continues to impose economic burden on households and the health system. However, evidence on the societal and health system costs associated with malaria remains limited. This study aimed to estimate both the direct and indirect costs of treating uncomplicated and severe malaria among children under five years in western Kenya from both health system and societal perspectives. Methods A cross-sectional cost-of illness study was conducted in three counties in western Kenya. A total of 240 children under five years with laboratory-confirmed malaria (120 uncomplicated and 120 severe cases) were enrolled using consecutive sampling at participating health facilities. Cost data were collected through caregiver interviews and facility records. Direct medical, direct non-medical, and indirect costs were estimated from a societal perspective. Provider or health system costs were estimated using facility data and national price lists. Mean costs per malaria episode were calculated, and deterministic one-way sensitivity analyses were conducted to assess the robustness of key cost assumptions. Results Most children with malaria lived in rural areas (178/240, 74%). A higher proportion of uncomplicated (97/120, 81%) and severe (81/120, 68%) malaria cases were from rural areas compared with urban areas. Most caregivers (209/240, 87%) were female, and largely unemployed (151/240, 63%). Fever (173/240, 72%) was the common symptom, whereas convulsions (44/120, 37%) and vomiting (47/120, 39%) were more frequent in severe cases. Mean societal and health system costs per episode was substantially higher for severe malaria (US$117.34 and US$84.72) compared with uncomplicated malaria (US$8.68 and US$5.52), respectively. Indirect costs, particularly caregiver productivity losses, constituted a significant component of total costs. Sensitivity analyses indicated that caregiver time valuation was the main driver of societal cost estimates; however, across all scenarios the cost of severe malaria remained substantially higher than that of uncomplicated malaria. Conclusions Malaria treatment among children imposes substantial societal costs in Kenya, with markedly higher costs associated with severe malaria compared with uncomplicated cases. Strengthening early diagnosis and timely treatment may help prevent progression to severe disease and reduce the economic burden on households and the health system.