Online PhD conferral mrs. Joëlle S. Castellani
Supervisors: prof. dr. mr. S.M.A.A. Evers, prof. dr. A.T.G. Paulus
Co-supervisors: dr. M. Gomes, Switzerland, prof. dr. B. Mihaylova, University of Oxford
Key words: malaria, access to health care, out-of-pocket costs, community-based intervention, community health workers, Africa
"Delayed access to care for childhood malaria: Financial determinants and economic consequences"
This thesis describes the economic and financial factors that influence access to healthcare of children in rural Africa, discusses the consequences of delayed access to diagnosis and treatment of malaria, and tests and evaluates the economic components of a strategy for reducing delays by bringing access closer to sick children in their community. The results show that the costs of severe illness constrain access to healthcare facilities and delay immediate care. This can cause the illness to progress into more severe stages and can increase the risks of disability and death. Interventions that bring effective diagnosis and treatment closer to the patient increases and speeds up access to diagnosis and treatment, reduce illness costs and clinical episode duration. The time allocated by community health workers (CHWs) to bring healthcare closer to patients did not increase significantly.
