Household Willingness to Pay for Azithromycin Treatment for Trachoma Control in the United Republic of Tanzania. (Research)

By Frick, Kevin D.; Lynch, Matthew et al. | Bulletin of the World Health Organization, March-April 2003 | Go to article overview
Save to active project

Household Willingness to Pay for Azithromycin Treatment for Trachoma Control in the United Republic of Tanzania. (Research)


Frick, Kevin D., Lynch, Matthew, West, Sheila, Munoz, Beatriz, Mkocha, Harran A., Bulletin of the World Health Organization


Voir page 106 le resume en francais. En la pagina 106 figura un resumen en espanol.

Introduction

Trachoma is an important cause of blindness worldwide, with estimates of 5-7 million blind and 300-500 million more affected (1). Children form the main reservoir of infection in endemic communities, although complications from blinding occur mainly in adults. Blinding trachoma is caused by repeated or prolonged infection with Chlamydia trachomatis, which results in scarring of the conjunctiva and inturning eyelashes which scratch the surface of the eye (trichiasis), causing corneal opacities. In hyperendemic areas such as the Kongwa district of central United Republic of Tanzania, the prevalence of active trachoma in preschool children is around 60%, and that of trichiasis in persons over 55 years of age is about 8% (2).

WHO recommends a four-pronged approach for trachoma control (referred to as SAFE) that includes community-wide treatment with antibiotics, health education, environmental changes, and trichiasis surgery (3, 4). Traditionally trachoma was treated using tetracycline, which is more readily available than azithromycin, but is more burdensome to administer. Pfizer, Inc., is continuing to make azithromycin donations in a growing consortium of countries. The combination of the promotion of a four-pronged approach, an antibiotic donation programme, and the formation of the Alliance for the Global Elimination of (blinding) Trachoma (GET2020), has spurred interest in trachoma control.

Successful trachoma control efforts require resources that are greater than the costs of antibiotics. Delivery of the antibiotics and provision of other aspects of the SAFE strategy are likely to be expensive. One study in Nigeria estimated the costs of distributing donated ivermectin to be equal to the entire annual government health expenditure (5). Even if, initially, philanthropy covers trachoma control programme expenses, the issue of cost recovery will likely arise as it takes years for control efforts to succeed. The components of the SAFE strategy most likely to be subject to cost-recovery efforts are surgery and antibiotics.

Cost-recovery programmes can have a negative impact on utilization of health services. Additionally, the need for repeated mass treatments for a disease that leads to blindness later in life may limit compliance. In the present study we tested for associations between willingness to pay for a follow-up treatment with azithromycin and measures of socioeconomic status, risk factors for active trachoma, and perceived impact of an initial treatment with azithromycin.

Several factors suggest that it is important to assess the willingness to use resources for future azithromycin treatment. First, while the SAFE strategy is integrated from a health planning perspective, the affected population does not necessarily perceive it as an integrated strategy. Second, azithromycin treatment is a key component of the Tanzanian national trachoma control programme. The willingness to pay for azithromycin treatment specifically can be analysed since at the time of the study the villages concerned had only had the antibiotic component of the SAFE strategy, although all have subsequently been enrolled in the national programme. During the study, individuals with trichiasis were referred for additional treatment.

Information about who is willing to use personal resources for follow-up treatment will help to target the promotion of mass treatment programmes for communities with endemic active trachoma, thus maximizing the response to such programmes.

Conceptual model

In the context of our study, willingness to pay measures the total value of azithromycin treatment for those affected (6). A household's willingness to pay is determined by the household decision-makers' preferences and constraints, which are in turn a function of resources and "prices" such as the value and amount of time required to obtain treatment (opportunity costs).

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article

Household Willingness to Pay for Azithromycin Treatment for Trachoma Control in the United Republic of Tanzania. (Research)
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?