The Health Outcomes Research Unit (HORU) was established to carry out outcomes research for all sectors of the healthcare industry and to strengthen capacity within the fields of health outcomes and in particular health- and pharmaco-economics.




Researcher: Dr Marian Loveday

Designation: Specialist Scientist , South African Medical Research Council

Study:  Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa

Summary: KwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (TB), multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection.

To determine the most effective care model by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital.

A non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home and had easier access to care, and home-based care was available from treatment initiation.

Four community-based sites treated 736 patients, while 813 were treated at the centralised hospital (total = 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, P = 0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, P = 0.22). On multivariate analysis, MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR 1.43, P = 0.01). However, outcomes at the four community-based sites were heterogeneous, with Site 1 demonstrating that home-based care was associated with an increased treatment success of 72% compared with success rates of 52-60% at the other three sites.

Community-based care for MDR-TB patients was more effective than care in a central, specialised hospital. Home-based care further increased treatment success.



Researcher: Mr Resign Gunda

Designation: PhD student

Study: The Economic Burden of Malaria on Rural Households in Gwanda District, Zimbabwe

Summary: Introduction: Malaria is a serious public health problem in sub-Saharan Africa and is a leading cause of morbidity and mortality and is one of the leading causes of morbidity and mortality. About 50 % of the Zimbabwean population lives in malaria prone areas and are therefore at high risk of infection. Besides being a major health problem, malaria imposes an economic burden in populations vulnerable to the disease.

Aim: To estimate the household economic burden due to malaria in a rural community.

Methods: A cross-sectional household survey was conducted to generate data for estimating costs incurred by households due to malaria. Households (n=80) where there had been a case of malaria during the study period were selected for the survey. Interviewer-administered closed-ended questionnaires were used determine expenditure on treatment, transport, loss of productive time as well as failure to perform normal daily activities. The data was analysed using the SPSS programme.

Results: The findings indicated that households spent an average of US$3.22 and $56.60 as direct costs for managing an uncomplicated and a complicated malaria episode per family member respectively. A household loses an average of 7 productive working days per each malaria episode per person resulting in an average loss of 24% of the monthly household income through this indirect cost.

Conclusions: Malaria imposes a significant economic burden on households in poor and vulnerable communities of Gwanda. Such costs should be considered in assessing the burden due to malaria.