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Costs and health consequences of chlamydia management strategies among pregnant women in sub-Saharan Africa
  1. Maria Romoren (maria.romoren{at}medisin.uio.no)
  1. Institute of General Practice and Community Medicine, University of Oslo, Norway
    1. Fatma Hussein (drfahussein{at}yahoo.com)
    1. Department of HIV/AIDS Prevention and Care, Ministry of Health, Botswana
      1. Tore W Steen (tsteen{at}gov.bw)
      1. Department of HIV/AIDS Prevention and Care, Ministry of Health, Botswana
        1. Manonmany Velauthapillai (velamano{at}hotmail.com)
        1. National Health Laboratory, Botswana
          1. Johanne Sundby (johanne.sundby{at}medisin.uio.no)
          1. Institute of General Practice and Community Medicine, University of Oslo, Norway
            1. Per Hjortdahl (per.hjortdahl{at}medisin.uio.no)
            1. Institute of General Practice and Community Medicine, University of Oslo, Norway
              1. Ivar Sønbø Kristiansen (ivarsk{at}c2i.net)
              1. Institute of Health Management and Health Economics, University of Oslo, Norway

                Abstract

                Objectives: Chlamydia is the most common bacterial sexually transmitted infection worldwide and a major cause of morbidity- particularly among women and neonates. We compared costs and health consequences of using point-of-care (POC) tests with current syndromic management among antenatal care attendees in sub-Saharan Africa. We also compared erythromycin with azithromycin treatment and universal with age-based chlamydia management.

                Methods: A decision analytic model was developed to compare diagnostic and treatment strategies, using Botswana as a case. Model input was based upon 1) a study of pregnant women in Botswana, 2) literature reviews and 3) expert opinion. We expressed the study outcome in terms of costs (US$), cases cured, magnitude of overtreatment and successful partner treatment.

                Results: Azithromycin was less costly and more effective than was erythromycin. Compared to syndromic management, testing all attendees on their first visit with a 75% sensitive POC test increased the number of cases cured from 1 500 to 3 500 in a population of 100 000 women, at a cost of US$38 per additional case cured. This cost was lower in high-prevalence populations or if testing was restricted to teenagers. The specific POC tests provided the advantage of substantial reductions in overtreatment with antibiotics and improved partner management.

                Conclusions: Using POC tests to diagnose chlamydia during antenatal care in sub-Saharan Africa entails greater health benefits than syndromic management does- and at acceptable costs- especially when restricted to younger women. Changes in diagnostic strategy and treatment regimens may improve people's health and even reduce health care budgets.

                • Chlamydia trachomatis
                • Costs and Cost Analysis
                • Developing countries
                • Maternal Health Services
                • Point-of-care tests

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