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Table 1 SAFARI Model Inputs for Zambia

From: Impact of substandard and falsified antimalarials in Zambia: application of the SAFARI model

Model Input

Point Estimate

Range/SD

Source

Demographic & Epidemiological Data

 < 5 Population At Risk

2,750,360

 

President's Malaria Initiative 2019 [6]

 Untreated Case Progression to Severe

0.13

0.07–0.30

Lubell 2011 [23]

 Treatment Failure Progression to Severe

0.02

 

Lubell 2011 [23]

 Inpatient Case Fatality Rate

0.08

 

Camponovo 2017 [24]

 Case Fatality Rate Outside of Hospital

0.15

 

Camponovo 2017 [24]

 Inpatient Severe Case Rate of NS

0.032

0.0014

Lubell 2011 [23]

Care-Seeking Behavior (%)

 Public Facilities

67.5%

 

Zambian DHS 2018 [25]

 Private Facilities

4.6%

 

Zambian DHS 2018 [25]

 Pharmacies

0.3%

 

Zambian DHS 2018 [25]

 Drug Stores

0.8%

 

Zambian DHS 2018 [25]

 CHWs

3.0%

 

Zambian DHS 2018 [25]

 Self/Neighbors

9.2%

 

Zambian DHS 2018 [25]

 No Treatment

14.6%

 

Zambian DHS 2018 [25]

Probability facility has antimalarial in stock

 Public Facilities

99.8%

 

ACTwatch 2014 [8]

 Private Facilities

90.5%

 

ACTwatch 2014 [8]

 Pharmacies

88.8%

 

ACTwatch 2014 [8]

 Drug Stores

92.1%

 

ACTwatch 2014 [8]

Medication Effectiveness

 ACTs Effectiveness

0.962

0.044

Nambozi 2011, Bassat 2009, 4ABC 2011, Hamainza 2014, Pekyi 2016, Chanda 2006, Depoortere 2005 [26,27,28,29,30,31,32]

 SP Effectiveness

0.759

0.741–0.905

Depoortere 2005 [31]

 Other Drug Effectiveness

0.88

0.041

Yeka 2013, Verret 2011 [33, 34]

Substandard and Falsified Parameters

 Proportion of SF Antimalarials (API > 85%)

0.103

 

Bate 2010 [15]

 Increase in Probability of Transitioning to Severe Malaria if Receive SF Drug

50%

 

Assumption

Treatment Adherence

 

Coefficient

 

 Good: Probably Adherent

0.3940

1

Depoortere 2004 [35]

 Fair: Perhaps Not Adherent

0.3940

0.5

Depoortere 2004 [35]

 Poor: Definitely Not Adherent

0.2120

0

Depoortere 2004 [35]

Patient Costs for Drugs

Public Facilities

  Average Costs of ACTs

$0.00

 

ACTwatch 2014 [8]

  Average Costs of SP

$0.00

 

ACTwatch 2014 [8]

  Average Costs of Other Treatments

$0.00

 

ACTwatch 2014 [8]

Private Facilities

  Average Costs of ACTs

$5.23

$2.09 - $12.81

ACTwatch 2014 [8]

  Average Costs of SP

$0.65

$0.33 - $1.96

ACTwatch 2014 [8]

  Average Costs of Other Treatments

$5.23

$0.00 - $8.24

ACTwatch 2014 [8]

Pharmacies

  Average Costs of ACTs

$5.23

$3.92 - $7.85

ACTwatch 2014 [8]

  Average Costs of SP

$0.33

$0.26 - $0.65

ACTwatch 2014 [8]

  Average Costs of Other Treatments

$5.49

$3.84 - $5.49

ACTwatch 2014 [8]

Drug Stores

  Average Costs of ACTs

$1.96

$1.31 - $3.14

ACTwatch 2014 [8]

  Average Costs of SP

$0.39

$0.26 - $0.39

ACTwatch 2014 [8]

  Average Costs of Other Treatments

$1.37

$0.00 - $0.00

ACTwatch 2014 [8]

Other Costs to Patients

  Transport Costs (Public, Private)

$2.51

$1.25 - $6.26

Aspler 2008 [36]

  Transport Costs (Pharmacies, Drug Stores)

$0.25

 

Assumption based on: Aspler 2008 [36]

  Costs of Special Food for Children

$3.12

$0.96 - $6.26

Aspler 2008 [36]

  Costs per Pediatric Malaria Hospitalization

$10.56

$2.69

WHO CHOICE 2010 [37]

  Productivity Loss per Sick Day

$3.21

 

Calculation based on World Bank 2019 [38]

  Productivity Loss from Death, Discounted at 3%

$30,155.30

 

Calculation based on World Bank 2019 [38]

  NS Disability Productivity Loss, Discounted at 3%

$12,477.37

 

Calculation based on World Bank 2019 [38]

Facility Costs

  Facility Costs per Testing

$0.96

$0.21

Chanda 2009 [39]

  Facility Costs per ACTs

$2.00

$0.50

Chanda 2007 [40]

  Facility Costs per SP

$0.27

$0.06

Chanda 2007 [40]

  Facility Costs per Other Treatments

$0.11

 

Calculation

  Public Facility Costs per Consultation

$6.40

$1.51

Chanda 2007 [40]

  Facility Costs per Pediatric Malaria Hospitalization

$84.07

$6.72

Comfort 2014 [41]

  Costs per CHW Treatment

$1.01

$0.19

Chanda 2011 [42]

  Costs per CHW Testing

$3.14

$0.79

Haimanza 2014 [43]

  Costs per CHW Visit

$3.32

$0.79

Chanda 2011 [42]

  1. ACTs artemisinin-based combination therapies, API active pharmaceutical ingredient, CHWs community health workers, DHS demographic and health survey, NS neurologic sequelae, SD standard deviation, SF substandard or falsified, SP sulfadoxine-pyrimethamine, WHO World Health Organization