Malaria transmission in The Gambia decreased substantially over the last 20 years thanks to the scale-up of control interventions. However, malaria prevalence is still relatively high in eastern Gambia and represents both a health and a financial burden for households. This study aims to quantify the out-of-pocket costs and productivity losses of seeking malaria treatment at household level. A household survey was carried out through in-person interviews. Respondents were asked about malaria prevention methods, their treatment-seeking behaviour, and any costs incurred for transport, services, food, and/or overnight stays. A bottom-up costing approach was used to calculate the unit cost of treatment and a tobit regression approach to investigate cost drivers. The survey included 864 respondents, mainly subsistence farmers. Most respondents (87%) considered malaria to be a problem affecting their ability to perform their regular duties. Respondents preferred going to a health facility for treatment. The primary reason for not going was related to costs; 70% of respondents incurred costs for seeking health care, with a median of £3.62 (IQR: £1.73 to £6.10). The primary driver of cost was living in one of the villages that are off the main road and/or far from health facilities. 66% reported productivity loss of 5 working days on average during a malaria episode of them or their child. Although malaria prevalence is decreasing and treatment is provided free of charge, households seeking treatment are confronted with out-of-pocket expenditures and lost working days; particularly in remote villages.

中文翻译：

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冈比亚上游地区寻求疟疾治疗的家庭面临的成本和障碍

由于控制干预措施的扩大，冈比亚的疟疾传播在过去 20 年中大幅下降。然而，冈比亚东部的疟疾流行率仍然相对较高，对家庭来说既是健康负担，也是经济负担。本研究旨在量化在家庭层面寻求疟疾治疗的自付费用和生产力损失。家庭调查是通过面对面访谈进行的。受访者被问及疟疾预防方法、他们寻求治疗的行为以及交通、服务、食物和/或过夜住宿所产生的任何费用。自下而上的成本计算方法用于计算治疗的单位成本，并使用 Tobit 回归方法来调查成本驱动因素。调查包括 864 名受访者，主要是自给自足的农民。大多数受访者（87%）认为疟疾是一个影响他们履行日常职责能力的问题。受访者更愿意去医疗机构接受治疗。不去的主要原因与成本有关；70% 的受访者因寻求医疗保健而产生费用，中位数为 3.62 英镑（IQR：1.73 至 6.10 英镑）。成本的主要驱动因素是住在远离主要道路和/或远离卫生设施的村庄之一。66% 的人报告说他们或他们的孩子在疟疾发作期间平均损失 5 个工作日。尽管疟疾流行率正在下降并且免费提供治疗，但寻求治疗的家庭面临着自费支出和工作日损失；特别是在偏远的村庄。