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The Economic Impact of Malaria in Africa: A Critical Review of the Evidence
Abstract
Information on the economic burden of malaria in Africa is needed to target interventions efficiently and equitably, and to justify investment in research and control. A standard method of estimation has been to sum the direct costs of expenditure on prevention and treatment, and the indirect costs of productive labour time lost. This paper discusses the many problems in using such data to reflect the burden to society or the potential benefits from control. Studies have generally focussed on febrile illness, overestimating the burden of uncomplicated malaria, but underestimating the costs of severe illness, other debilitating manifestations, and mortality. Many use weak data to calculate indirect costs, which fail to account for seasonal variations, the difference between the average and marginal product of labour, and the ways households and firms 'cope' in response to illness episodes. Perhaps most importantly, the costs of coping mechanisms in response to the risk of disease are excluded, although they may significantly affect productive strategies and economic growth. Future work should be rooted in a sound understanding of the health burden of malaria and the organisation of economic activities, and address the impact on the productive environment, and epidemiological and socio-economic geographical variation.
... The economic costs of malaria can be classified into direct and indirect costs [4,7,8]. First, the direct malaria costs contain a combination of household and government expenditures on treating and preventing malaria, as illustrated in Fig. 2. Household expenditure on malaria treatment consists of individual or family spending on consultation fees, drugs, transport and the cost of subsistence at a distant health facility, and costs of accompanying family members during hospital stays [9]. ...
... First, the direct malaria costs contain a combination of household and government expenditures on treating and preventing malaria, as illustrated in Fig. 2. Household expenditure on malaria treatment consists of individual or family spending on consultation fees, drugs, transport and the cost of subsistence at a distant health facility, and costs of accompanying family members during hospital stays [9]. Household expenditure on malaria-related prevention includes costs of buying preventive means, for instance, mosquito coils, aerosol sprays, bed nets and mosquito repellents [7]. According to the malaria-endemic degree, these means can be used differently across regions and counties. ...
... Government expenditure on malaria-related treatment, control and prevention includes spending on maintaining health facilities and health care infrastructure, publicly managed vector control (e.g., insecticide-treated bed nets, indoor residual spraying, larviciding, communitywide campaigning), education and research. The indirect costs of malaria consist of losses in productivity or income due to illness or deaths [7,9], as shown in Fig. 2. Losses due to sickness can be measured as the cost of lost workdays due to illness or caring for sick family members. In contrast, losses due to deaths can be calculated as discounted future lifetime earnings of those who die. ...
Background
Malaria remains a public health problem in Kenya despite several concerted control efforts. Empirical evidence regarding malaria effects in Kenya suggests that the disease imposes substantial economic costs, jeopardizing the achievement of sustainable development goals. The Kenya Malaria Strategy (2019–2023), which is currently being implemented, is one of several sequential malaria control and elimination strategies. The strategy targets reducing malaria incidences and deaths by 75% of the 2016 levels by 2023 through spending around Kenyan Shillings 61.9 billion over 5 years. This paper assesses the economy-wide implications of implementing this strategy.
Methods
An economy-wide simulation model is calibrated to a comprehensive 2019 database for Kenya, considering different epidemiological zones. Two scenarios are simulated with the model. The first scenario (GOVT) simulates the annual costs of implementing the Kenya Malaria Strategy by increasing government expenditure on malaria control and elimination programmes. The second scenario (LABOR) reduces malaria incidences by 75% in all epidemiological malaria zones without accounting for the changes in government expenditure, which translates into rising the household labour endowment (benefits of the strategy).
Results
Implementing the Kenya Malaria Strategy (2019–2023) enhances gross domestic product at the end of the strategy implementation period due to more available labour. In the short term, government health expenditure (direct malaria costs) increases significantly, which is critical in controlling and eliminating malaria. Expanding the health sector raises the demand for production factors, such as labour and capital. The prices for these factors rise, boosting producer and consumer prices of non-health-related products. Consequently, household welfare decreases during the strategy implementation period. In the long run, household labour endowment increases due to reduced malaria incidences and deaths (indirect malaria costs). However, the size of the effects varies across malaria epidemiological and agroecological zones depending on malaria prevalence and factor ownership.
Conclusions
This paper provides policymakers with an ex-ante assessment of the implications of malaria control and elimination on household welfare across various malaria epidemiological zones. These insights assist in developing and implementing related policy measures that reduce the undesirable effects in the short run. Besides, the paper supports an economically beneficial long-term malaria control and elimination effect.
... The tool supports budget planning, but it does not assess executed services and does not include indirect costs. Although frameworks for analysis of the economic costs of malaria have been proposed [6][7][8] comprehensive estimates that break down costs by different stakeholders (health providers, individuals, community), that consider inequities across geographies, and that account for productivity losses and other non-tangible costs are scarce. Only two reviews on the economic burden of malaria are available [7][8][9]. ...
... Although frameworks for analysis of the economic costs of malaria have been proposed [6][7][8] comprehensive estimates that break down costs by different stakeholders (health providers, individuals, community), that consider inequities across geographies, and that account for productivity losses and other non-tangible costs are scarce. Only two reviews on the economic burden of malaria are available [7][8][9]. The first, published in 2003, compiled evidence on direct and indirect costs of malaria for both families and the healthcare system [7]. They estimated monthly per capita expenditures incurred by households for malaria prevention and treatment ranging from, respectively, US$0.05 and US$0.41 in Malawi to US$2.10 and US$3.88 in the urban area of Cameroon. ...
... Only two reviews on the economic burden of malaria are available [7][8][9]. The first, published in 2003, compiled evidence on direct and indirect costs of malaria for both families and the healthcare system [7]. They estimated monthly per capita expenditures incurred by households for malaria prevention and treatment ranging from, respectively, US$0.05 and US$0.41 in Malawi to US$2.10 and US$3.88 in the urban area of Cameroon. ...
Background
Quantifying disease costs is critical for policymakers to set priorities, allocate resources, select control and prevention strategies, and evaluate the cost-effectiveness of interventions. Although malaria carries a very large disease burden, the availability of comprehensive and comparable estimates of malaria costs across endemic countries is scarce.
Methods
A literature review to summarize methodologies utilized to estimate malaria treatment costs was conducted to identify gaps in knowledge.
Results
Only 45 publications met the inclusion criteria. They utilize different methods, include distinct cost components, have varied geographical coverage (a country vs a city), include different periods in the analysis, and focus on specific parasite types or population groups (e.g., pregnant women).
Conclusions
Cost estimates currently available are not comparable, hindering broad statements on the costs of malaria, and constraining advocacy efforts towards investment in malaria control and elimination, particularly with the finance and development sectors of the government.
... Research findings that have been undertaken to assess the worldwide economic strain and cost of malaria have typically focused on personal and governmental healthcare costs related to disease and even some estimate of the revenue that is forfeited due to malaria mortality and morbidity [21][22][23][24][25]. In this context, "individual health care costs" refer to the money spent on one's own health in areas such as preventing disease, diagnostic, treatments, and maintenance [22]. ...
... Those in the bottom income quintile bear a disproportionately heavy burden, according to these findings [23,24]. However, the estimates, which are often less than 1% of GDP, fail to take into account the full extent to which the condition hinders long-term growth in the economy [25]. Essentially, conventional studies have employed accounting methods that assume the monetary costs of malaria can be calculated by multiplying the average cost of a personal episode of illness by the total number of cases experienced, and then adding any operating expenses frittered away in prevention and treatment [22][23][24]. ...
... Essentially, conventional studies have employed accounting methods that assume the monetary costs of malaria can be calculated by multiplying the average cost of a personal episode of illness by the total number of cases experienced, and then adding any operating expenses frittered away in prevention and treatment [22][23][24]. Such approaches may be reasonable when there are only a few cases of a disease (for example, when there are diseases in the United States and other countries due to tourism in malaria-endemic regions), but they make little sense when applied to circumstances with high transmission [25]. ...
Malaria is one of the deadliest infectious diseases in Africa. Many measures have been taken over the past few years to reduce the burden of malaria on public health following the recommendation of WHO, still, malaria has continued to rake devastation in Africa. Combating malaria in Africa has grown into an international concern. The eradication of malaia is a long-standing goal of public health initiatives globally. The development of vaccines will go a long way to provide the required immunity needed for the people living with malaria or vulnerable to malaria. It is imperative that a vaccine should be produced and rolled out for use, especially during the time of the COVID-19 pandemic when attention is given to mitigating the impact of the pandemic on public health. The malaria vaccine will reduce the number of hospital admission for malaria illness among children and other age groups. Africa will need to build strong innovations to overcome country-specific challenges in vaccination drive, human resources, and supply chain management. Accelerating education, sensitization, diagnosis, and eradication through joint efforts of the government, healthcare professionals and general population will help to prevent the dual synchronous epidemic of COVID-19 and Malaria in Africa.
... For paid workers, the daily income loss was estimated based on the reported daily wages of the patients and caregivers. The value of daily productivity for unemployed individual was assumed based on age-specific wage and was divided into three groups: adult, teenager (aged 11 to 17) and children aged 5 to 10 [18,36]. Although the children were not involved in income generating activities but they lost school days and thus we estimated cost of children following other studies [18,36]. ...
... The value of daily productivity for unemployed individual was assumed based on age-specific wage and was divided into three groups: adult, teenager (aged 11 to 17) and children aged 5 to 10 [18,36]. Although the children were not involved in income generating activities but they lost school days and thus we estimated cost of children following other studies [18,36]. Similarly, we also estimated average daily wages for unemployed individuals following other studies [18,36] and considered one-half of average patient's daily wages (who were involved in income generating activities) for adults and teenagers (working at own home, student), and one-quarter of patient's daily wages for children [21,36]. ...
... Although the children were not involved in income generating activities but they lost school days and thus we estimated cost of children following other studies [18,36]. Similarly, we also estimated average daily wages for unemployed individuals following other studies [18,36] and considered one-half of average patient's daily wages (who were involved in income generating activities) for adults and teenagers (working at own home, student), and one-quarter of patient's daily wages for children [21,36]. ...
The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 [95% CI: 24.55, 30.23] (2,147 BDT), 17% of the average monthly income of the households. The average cost of illness for patient with non-severe diarrhea was US$ 6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household’s income. Preventing diarrhea preserves health and supports financial livelihoods.
... This could be explained by the nancial crisis that is raging in the Congo DR in general and in the Eastern Kasai province in particular, especially as the main mining company of this area (Mining Society of Bakwanga or MIBA) has been bankrupt for several years. Our results corroborate literature that describes malaria as disease of poverty [1,8,9]. Literature adds that improving social and economic conditions reduces the burden of malaria [2,5,10,11]. ...
... (range $8.5-$79.94) or even a little more in case of recovering ($40.83±10.95) is a greater sum than the monthly income of the most households as 81.5% earned less than US $30 a month of which the bulk expenditure is devoted to basic need which is food [3,9]. As the majority of households live below the poverty line, these results show that direct cost of severe malaria management in hospital is high for developing countries. ...
... This is a serious economic burden for household; especially the latter shall assume all costs allocated to the hold in charge of the disease as system of health insurance is not yet operational in this community. These results corroborate literature that describes malaria as cause of poverty [1,8,9]. Studies previously conducted on malaria direct costs in this background are almost non-existent. ...
Background: Leading cause of morbidity and mortality of the Congolese child, malaria especially severe is so much a source of economic losses, both direct (related to curative treatment or prevention) and indirect (due to absenteeism or the decrease of productivity), non-negligible for Mbujimayi’s population whose majority lives below the poverty line.
Methods: This prospective study related to the direct cost of in-hospital hold in charge of severe malaria among children of 6 to 59 months, as well as the factors influencing it, was undertaken from July 01, 2012 to June 30, 2013 in the Provincial Hospital Dipumba. Consultation, laboratory tests, medication and hospitalization were the components of the direct cost. EPI Info and SPSS software were used to analyse data.
Results: Severe malaria accounted for 70.9% of admissions (534 of 753). The subject was generally male (55.1%), under 3 years of age (28.6±17.5 months), having received no correct anti-malarial treatment before admission (81.5%), brought urgently in serious condition (95.5%), subjected to a low rate of laboratory tests (4.8±1.6) and treated mainly with quinine infusion (93.25%). Recovery amounted to 79.2% against 7.3% of deaths most often early. The majority of affected households (81.5%) were very poor as earning less than $ 30/month. The mean direct cost of the hold in charge of a severe malaria episode rose to US $ 38.6±11.2 (range US $ 8.5-79.94) of which 74% were bound to medication, 11% to consultation, 8% to hospitalization and 7% to laboratory tests. Age, quality of treatment before admission, severity at admission, severe anaemia and disease outcome were the factors influencing this direct cost.
Conclusion: Malaria is a costly disease in relation to the standard of living of our population and severe malaria is the main reason for hospitalization among children aged 6 to 59 months. It is necessary to reinforce management capabilities of cases correctly and early so much at home that in hospital and to streamline medical prescriptions in order to reduce costs led by malaria.
... Evidence from some countries find that individual lose their workdays due to different mosquito-borne diseases. For a sick adult in Ghana, average time loss per episode of illness ranges from 1 to 5 days, 18 days in Ethiopia, 2.7 days in Malawi and 6-11 days in Sudan (Chima et al., 2003). This might bear significant rise in treatment cost (i.e. ...
... A study conducted in Pakistan finds that households spend wide range of money as averting and treatment expenditure to combat burden of mosquito-borne diseases for which they have to bear US$ 5.10 and US$ 4.84, respectively (Khan et al., 2019). Another study finds that average health cost per episode of mosquito-borne disease is US$ 17.48 in Malawi,US$ 17.20 in Sudan and US$ 24.89 for low-income households in Africa (Chima et al., 2003;Hennessee et al., 2017). Improvement of treatment services merely has little impact on cutting down the expenditure; therefore, preventive strategies like use of cost-effective repellent may justify the potential significance in health outcome. ...
... Treatment cost: Treatment costs are referred to those expenses incurred with the aim of treating or eliminating diseases. They include medication cost, doctor's fee, diagnostic test fee and transportation cost to visit medical facilities (Chima et al., 2003;Khan et al., 2019). ...
Purpose
Mosquito problem per se arises with diverse weather patterns. With regard to mosquito diseases, people intrinsically use repellents regardless of the harmful effect. The use of repellents like coil, spray, liquid vaporizer and mosquito cream triggers indoor congestion, and thereby respiratory diseases. Eventually, people have to bear high out-of-pocket costs.
Design/methodology/approach
This study has applied a stratified systematic sampling technique taking 120 adult individuals from residential and slum areas covering users and non-users of mosquito repellents of Khulna city, Bangladesh. A structured questionnaire has been used to collect data from respondents.
Findings
Econometric techniques are exercised to examine the occurrence, severity and duration of different respiratory diseases. Results exhibit that poor and less-educated slum people are more prone to face respiratory diseases compared to residential people. The health cost of slum and residential people is estimated US$ 134 and US$ 9, respectively.
Originality/value
Finally, this study underpins arranging public health programs and taking averting actions as an impetus to raise consciousness toward the negative health effect of using mosquito repellents.
... Productivity losses resulting from malaria have a widespread impact, as infected individuals experience debilitating symptoms that hinder their ability to work or attend school. In particular, missed workdays, reduced productivity, and lower educational attainment are common outcomes [8,[14][15][16][17][18][19]. Additionally, malaria can cause agricultural workers to face challenges in tending to their crops or livestock, leading to decreased agricultural output and income [17][18][19]. ...
... In particular, missed workdays, reduced productivity, and lower educational attainment are common outcomes [8,[14][15][16][17][18][19]. Additionally, malaria can cause agricultural workers to face challenges in tending to their crops or livestock, leading to decreased agricultural output and income [17][18][19]. The repercussions can be dire, leading to significant nutritional and economic hardships, particularly in resource-challenged rural communities that depend on subsistence agriculture and immediate natural resources for their livelihood. ...
The mosquito-borne disease (malaria) imposes significant challenges on human health, healthcare systems, and economic growth/productivity. This study develops and analyzes a model to understand the interplay between malaria dynamics, economic growth, and transient events. The study uncovers varied effects of disease and economic parameters on model outcomes, highlighting the interdependence of the reproduction number ( R 0 ) on both disease and economic factors, and a reciprocal relationship where malaria diminishes economic productivity, while higher economic output is associated with reduced malaria prevalence. This emphasizes the intricate interplay between malaria dynamics and socio-economic factors. Also, the study offers insights into malaria control and underscores the significance of optimizing external aid allocation, especially favoring an even distribution strategy, with the most significant reduction observed in the equal monthly distribution strategy compared to longer distribution intervals. Furthermore, the study shows that controlling malaria in high mosquito biting areas with limited aid, low technology, inadequate treatment, or low economic investment is challenging. The model exhibits a backward bifurcation implying that sustainability of control and mitigation measures is essential even when R 0 is slightly less than one. Additionally, there is a parameter regime for which long transients are feasible. Long transients are critical for predicting the behavior of dynamic systems and identifying factors influencing transitions; they reveal reservoirs of infection, vital for disease control. Policy recommendations include prioritizing sustained control measures, optimizing external aid allocation, and reducing mosquito biting for effective disease control.
... However, this 10 percent figure is somewhat arbitrary because it may not be catastrophic for high income household as that can cut back on luxuries or for resilient households that can mobilize asset to pay for treatment (Russell, 1996) [39] . Direct and indirect costs will be influenced by type and severity of illness In situations of poverty, where households struggle to meet daily food and fuel needs, the loss of a daily wage due to illness or a relatively small treatment expense is likely to trigger such strategies (Russell 1996, Russell, 2001, Pryer, 1989 [38,39] including claims on resources outside the household such as social network or local organizations that offer credit ( [8,69] with respect to direct costs, all studies measure medical cost but some ignore non-medical costs such as transport. The scope of indirect cost measurement varies considerably across studies. ...
... The study is focused in Rivers State, in the forest zone. The forest zone covers mainly the southern states in Nigeria, including the south-west, southeast and the south-south (Jimoh 2007) [17] , Chima et al (2003) [8] , Ukpai ...
Purpose: This study is aimed at evaluating the economic burden of malaria treatment among households in Port Harcourt, Rivers State Nigeria. Methodology: A correlation survey research design was adopted for this study and a sample size of 338 was determined from a target population of 2,200 using Yamane formula. Findings: There are significant positive relationships between economic burden (direct and indirect costs) of treating malaria infection and the disposable income as well as high rate of poverty of the sampled households in Rivers State, Nigeria. Recommendations: The study identifies and recommends the need for government to intensify efforts in malaria elimination through effective eradication programme, universal health coverage, national health insurance scheme and free malaria treatment. In addition, government is called upon to strengthen the health system in Nigeria and provide effective leadership as avenue to mitigate the huge economic burden of malaria treatment in the country. Originality/value: This study contributes to malarial infection research by providing empirical evidences of the relationships that exist between the direct and the indirect costs of treating the disease and its effects on the disposable income and the living standard of the people.
... The result of this is that, particularly in rural areas, there are not enough facilities (health centers, staff, and medical equipment). Cost of illness studies is used to determine the financial impact of a disease (or disorders) (Chima and Goodman, 2003). This is a rough estimate of how much could be gained or saved if a disease were to be wiped out. ...
... First, different studies include different people in their measurements of lost time: some only include "economically active" family members and exclude children or the elderly (Attanayake et al., 2000); others include children's days off from school or, if they do work, give weight to their lost activity days based on estimates of productivity (Aikins, 1995). Furthermore, the scope of indirect expenses varies, but for the most part, it includes the time spent by the patient and caregiver seeking treatment as well as the morbidity period during which the patient or caregiver reduces or stops their productive activity (Chima and Goodman, 2003). A third comparative difficulty derives from the diverse approaches utilized to place a monetary value on time wasted. ...
The relationship between health status and technical efficiency cannot be over-emphasized although most researchers in the past have failed to recognize the possibility of an existing relationship between these variables. This study examined the cost implication of illnesses and their effect on the technical efficiency of oil palm processors in Edo State. A multistage sampling procedure was used to select 210 oil palm fruit processors in the study area. Data were analyzed using frequency counts, percentages, Cost-of-Illness estimation and Stochastic Production Frontier Analysis (SPF). Results revealed that the major illnesses experienced by the processors were malaria (100.0%), cough and catarrh (100.0%), back pain (98.8%), skin rash (78.9%) and nausea (76.6%). The estimated cost of illness was N165,338.80 with total time cost contributing 97.02% of this value for the period under consideration. SPF revealed that the mean technical efficiency of the oil palm processors was 0.75. Furthermore, palm fruits (β = 0.662, p<0.01), the volume of water used (β = 0.180, p<0.05), labor (β = 0.415, p<0.01) and processing experience (β = -0.110, p<0.05) increased the production of palm oil, while days of incapacitation (β = 0.445, p<0.01) increased technical inefficiency. The study concluded that illnesses had a negative influence on the technical efficiency of oil palm processors. The study recommended that stakeholders should create awareness of a healthy lifestyle and practical ways to maintain good health while ensuring continuous production.
... According to the WHO World Malaria Report, at the beginning of the 21st century, the incidence ranged from 350 to 500 million cases per year, of which 1 to 3 million ended in death [26,27]. In connection with these ominous data, any new sources of natural antimalarial agents are of great interest to medicine and pharmacology, as well as to the pharmaceutical industry [28][29][30]. ...
... A guaiane-type sesquiterpene, 1,7-epidioxy-5-guaiene (15) was found and later isolated from Axinyssa sponge [75], and an oxygenated sesquiterpenoid, 1,7-epidioxy-5guaien-4-ol called peroxygibberol (16), was isolated from a Formosan soft coral, Sinularia gibberosa, which demonstrated moderate cytotoxicity toward a human liver carcinoma cell line [76]. Structures (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) can be seen in Figure 2, and their biological activity is presented in Table 2. indicated that a hydroperoxy group and a vinyl group are attached at position-24 in both the R-and S-configurations [77], and cytotoxic steroid, (3β,5α,8α,24R,25R)-epidioxy-24,26-cyclocholesta-6,9(11)-dien-3-ol (19) was identified from Tethya sp. [78]. ...
Polycyclic endoperoxides are rare natural metabolites found and isolated in plants, fungi, and marine invertebrates. The purpose of this review is a comparative analysis of the pharmacological potential of these natural products. According to PASS (Prediction of Activity Spectra for Substances) estimates, they are more likely to exhibit antiprotozoal and antitumor properties. Some of them are now widely used in clinical medicine. All polycyclic endoperoxides presented in this article demonstrate antiprotozoal activity and can be divided into three groups. The third group includes endoperoxides, which show weak antiprotozoal activity with a reliability of up to 70%, and this group includes only 1.1% of metabolites. The second group includes the largest number of en-doperoxides, which are 65% and show average antiprotozoal activity with a confidence level of 70 to 90%. Lastly, the third group includes endoperoxides, which are 33.9% and show strong antipro-tozoal activity with a confidence level of 90 to 99.6%. Interestingly, artemisinin and its analogs show strong antiprotozoal activity with 79 to 99.6% confidence against obligate intracellular parasites which belong to the genera Plasmodium, Toxoplasma, Leishmania, and Coccidia. In addition to antiprotozoal activities, polycyclic endoperoxides show antitumor activity in the proportion: 4.6% show weak activity with a reliability of up to 70%, 65.6% show an average activity with a reliability of 70 to 90%, and 29.8% show strong activity with a reliability of 90 to 98.3%. It should also be noted that some polycyclic endoperoxides, in addition to antiprotozoal and antitumor properties, show other strong activities with a confidence level of 90 to 97%. These include antifungal activity against the genera Aspergillus, Candida, and Cryptococcus, as well as anti-inflammatory activity. This review provides insights on further utilization of polycyclic endoperoxides by medicinal chemists, pharmacologists, and the pharmaceutical industry.
... 2018). As well as direct effects on health, malaria is a major cause of poverty and underdevelopment in many countries, due to household and health system costs, absenteeism from school or work, reduced productivity, and premature death (Chima et al., 2008). Malaria-endemic countries are, on average, poorer by more than five-fold and have lower rates of economic growth than non-malaria endemic countries, with a mean growth of per-capita gross domestic product (GDP) of 0.4% per year versus 2.3% between 1965 and 1990 respectively (Sachs, 2002). ...
Malaria is caused by the Plasmodium parasite, which is transmitted by female Anopheles mosquitoes. There are five Plasmodium species that cause disease in humans; however, the most important species in terms of disease burden are Plasmodium falciparum, which is prevalent in sub-Saharan Africa, and Plasmodium vivax, which is more common in Asia and South America. There were an estimated 219 million malaria cases and 435,000 deaths worldwide due to malaria in 2017; Sub-Saharan Africa carries a disproportionately high share of the malaria burden, with 92% of cases and 93% of malaria deaths in 2017. As well as direct effects on health, malaria is a major cause of poverty and underdevelopment in many countries, due to household and health system costs, absenteeism from school or work, reduced productivity, and premature death. The objectives of this review are to bring to the fore, “the use of larvivorous fish species (that is, fish that eats mosquito larvae, e.g. tilapias and others) to control malaria transmission in Africa. A handful of research works provide evidence that larvivorous fish species can decrease immature mosquito populations in defined water bodies altering mosquitos’ metamorphosis. This is not surprising as we know a lot of fish species eat larvae, and this can reduce the proliferation of mosquitos’ population and malaria occurrences. It is highly recommended that, the Federal Government of Nigeria (FGN) and the African Union (AU) should embark on a national and regional Malaria Control Using Biological Method (MCUBM) of Larvivorous Fish Species (especially Cichlids, they are found in almost every ecosystems). We all know that the Synthetic Drug Method of Controlling Malaria has not yielded much results, as millions of people (expectant mothers, infants, young ones, adults and the aged/olds) still die of malaria in Africa. Therefore, it is high time we applied this method just like the Kenyan Government tried it; believe me, it will work because mosquitos are always in the increase during the raining season and malaria patients are more during this period. The fish species will equally bridge the protein demand of some Africans in no distance time.
... Health problem has been found to be a major influence on agricultural productivity in Nigeria and malaria has been a contributor to ill health in Africa (Chima et al., 2003;Fink and Masiye, 2015;Josephson et al., 2014;Mboera et al., 2010;Shayo et al., 2015). Malaria is highly endemic in Nigeria and it remains one of the major public health problems and a leading cause of morbidity and mortality in the country (Hay et al., 2010;Snow, 2015). ...
This study was conducted to establish a direct link of malaria incidence and rainfall pattern on farmer’s productivity. In a cohort of farming households in Kabba/Bunu Local Government Area of Kogi State, rainfall pattern, malaria incidence and household farming activities were carefully monitored on a weekly basis over an 8 months period (May to December, 2012). Malaria diagnosis was confirmed among febrile household members using Plasmodium falciparum Histidine-Rich Protein II (PfHRP2) malaria rapid diagnostic test (mRDT) kit (Parachek®). Data was collected on the factors of production as well as on the number of kilograms produced by the households for a range of crops such as maize, sorghum, cowpea, cassava, pepper, and yams. Data was also collected on febrile episodes among family members and other relatives within the households and on rainfall pattern. Descriptive statistics and production function were used to analyze the data. A total of 72 households participated in the study involving 432 household members. Malaria incidence was varied with rainfall pattern and crop productivity. Most of the farmers operate on a small scale and mainly cultivated cassava and yam. Malaria affected at least three-quarter of the household’s members. The study area recorded an average malaria prevalence of 103 per 1000, 7 rainy days and 256 mm of rainfall. Rainfall days and intensity was highest in the months of October and July respectively. Land, family labour, seed, and fertilizer are the major factors influencing crop production in the study area. The study revealed that cassava, yam, maize and pepper outputs were higher for households with a low incidence of malaria compared to high incidence households except for sorghum. Number of rain days in the study area is important to mosquito breeding which translate to increased malaria incidence thereby having negative effect on crop productivity. Creating awareness on the use of mosquito net and targeted seasonal malaria control strategies should be applied during the peak malaria prevalence period to reduce malaria incidence and enhance agricultural productivity in the study area.
... It is estimated that every minute a child aged under-five years dies from malaria, and in 2019, 20% of all deaths in this age group occurred in Nigeria [4]. Malaria also contributes to the poverty cycle through the reduction of productive labour time for adults, increase in missed school days for children, and greater health expenses for families and countries [5][6][7][8]. The significant morbidity and mortality caused by the disease, and its huge socioeconomic impact, made it a target of the Sustainable Development Goal 3 which aims to end the malaria epidemic, among other communicable diseases, by 2030 [9]. ...
Background
Malaria is still a disease of global public health importance and children under-five years of age are the most vulnerable to the disease. Nigeria adopted the “test and treat” strategy in the national malaria guidelines as one of the ways to control malaria transmission. The level of adherence to the guidelines is an important indicator for the success or failure of the country’s roadmap to malaria elimination by 2030. This study aimed to assess the fidelity of implementation of the national guidelines on malaria diagnosis for children under-five years and examine its associated moderating factors in health care facilities in Rivers State, Nigeria.
Methods
This was a descriptive, cross-sectional study conducted in Port Harcourt metropolis. Data were collected from 147 public, formal private and informal private health care facilities. The study used a questionnaire developed based on Carroll’s Conceptual Framework for Implementation Fidelity. Frequency, mean and median scores for implementation fidelity and its associated factors were calculated. Associations between fidelity and the measured predictors were examined using Mann Whitney U test, Kruskal Wallis test, and multiple linear regression modelling using robust estimation of errors. Regression results are presented in adjusted coefficient (β) and 95% confidence intervals.
Results
The median (IQR) score fidelity score for all participants was 65% (43.3, 85). Informal private facilities (proprietary patent medicine vendors) had the lowest fidelity scores (47%) compared to formal private (69%) and public health facilities (79%). Intervention complexity had a statistically significant inverse relationship to implementation fidelity (β = − 1.89 [− 3.42, − 0.34]). Increase in participant responsiveness (β = 8.57 [4.83, 12.32]) and the type of malaria test offered at the facility (e.g., RDT vs. no test, β = 16.90 [6.78, 27.03]; microscopy vs. no test, β = 21.88 [13.60, 30.16]) were positively associated with fidelity score.
Conclusions
This study showed that core elements of the “test and treat” strategy, such as testing all suspected cases with approved diagnostic methods before treatment, are still not fully implemented by health facilities. There is a need for strategies to increase fidelity, especially in the informal private health sector, for malaria elimination programme outcomes to be achieved.
... Huge resources are spent on malaria case management, selective vector control, intermittent prophylaxis during pregnancy, and epidemic detection and control. The amount spent on malaria in terms of prevention, treatment and loss of productivity can comprise a significant proportion of the annual income of poor households [7]. In a study conducted in rural communities in Nigeria, Onwujekwe et al. [8] reported that the cost of treating malaria illness by households accounted for 49.9 % of curative health care costs incurred by the households, which amounted to an average malaria expenditure of $ 1.84 per household per month. ...
Background
Malaria remains a disease of immense clinical and economic significance. Limited research has been carried out to estimate malaria treatment costs at the health care facility level using the patient’s perspective. The objectives of this study were therefore to determine the direct and indirect costs of malaria treatment among adult outpatients and to assess the patients’ perception of treatment costs.
Materials and methods
A cr oss-sectional study was conducted at the Pharmacy section of the General Practice Clinic, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. It involved adult outpatients diagnosed with malaria and who received a prescription of one or more anti-malarial medications. A cost-of-illness approach was employed in the assessment of costs of treatment of malaria per sick adult patient. Pre-tested semi-structured questionnaires were used in the study. Furthermore, self-reported incidence of malaria per year was assessed.
Results
The mean direct and indirect cost of tr eating malaria illness per adult outpatient was Nigerian Naira (NGN) 3417.70 ($ 20.34) and NGN 4870 ($ 29.0), respectively, giving a ratio of 0.7:1. Medications and laboratory tests for detection of malaria parasites contributed about 52 and 22% of the total direct cost, respectively. A total of 1592 malaria episodes were self-reported to occur annually, giving a mean value of 3.35 episodes per adult. Having a health care insurance was associated with the response that the cost of malaria treatment was low (P< 0.001).
Conclusion
The mean values of direct cost and indirect cost of treatment of malaria illness per adult outpatient were $ 20.34 and $ 29.0, respectively. Respondents who had health insurance perceived malaria treatment cost to be low, whereas those without such insurance felt otherwise.
... There are usually lower growth rates and minimal prosperity in a society where malaria thrives. It significantly impacts the economic well-being and health of individuals and nations [16]. Malaria has been recognized as instrument and a disease of poverty in sub-Saharan Africa. ...
This paper seeks to explore the significance and impact of malaria on Kenya's economic growth. This will help to understand the impact that malaria has or have had on household economic status especially for the vulnerable population in Kenya and how it has been unfolding slowly over time. This will also seek to understand the coping strategies adopted by the said population and the negative implications that have influenced these household's abilities to withstand malaria and other eventualities that may happen in the future. The risk and burden of malaria on vulnerable population together with its economic effects have been presented. Search engines such as Google Scholar and PubMed as well as related economics and medical journals were instrumental for this study. To protect the poor and vulnerable population against these adverse effects of malaria and from malaria itself, there is a great need to draft and enact policies that will be able control the effects as well as integration development and poverty reduction programs. The future work and focus for government and all stakeholders should be to focus more energy and work on achievable health services that will eliminate the burden of health especially malaria and its effects on Kenyan economic activities undertaken by the vulnerable population and to address the burden and risk of malaria on the productive under privileged within their environment, as well as study the epidemiological and socioeconomic geographical dissimilarities of the vulnerable population and the normal population.
... Pregnant women having suffered from intra-uterine growth retardation due to malaria have risk of abortion and giving birth to children with low weight causing increased neonatal mortality. Malaria survivors experience behavioral and cognitive disorders, measles, malnutrition, and respiratory diseases in the long run [14]. Apart from physical sufferings, it has socio-economic impact, too [15,16]. ...
Malaria is the leading cause of death globally, especially in sub-Saharan African countries claiming over 400,000 deaths globally each year, underscoring the critical need for continued efforts to combat this preventable and treatable disease. The objective of this study is to provide statistical guidance on the optimal preventive and control measures against malaria. Data have been collected from reliable sources, such as World Health Organization, UNICEF, Our World in Data, and STATcompiler. Data were categorized according to the factors and sub-factors related to deaths caused by malaria. These factors and sub-factors were determined based on root cause analysis and data sources. Using JMP 16 Pro software, both linear and multiple linear regression were conducted to analyze the data. The analyses aimed to establish a linear relationship between the dependent variable (malaria deaths in the overall population) and independent variables, such as life expectancy, malaria prevalence in children, net usage, indoor residual spraying usage, literate population, and population with inadequate sanitation in each selected sample country. The statistical analysis revealed that using insecticide treated nets (ITNs) by children and individuals significantly decreased the death count, as 1,000 individuals sleeping under ITNs could reduce the death count by eight. Based on the statistical analysis, this study suggests more rigorous research on the usage of ITNs.
... To transfer malaria morbidity in children and young adolescents on the productivity of working adults, we assumed that one year lost to child morbidity in the 0-4 age group and in the 5-14 age group was equivalent to one full year and 0.5 year productivity loss in working adults, respectively. 16,17,35,51,52,[55][56][57] We varied these assumed transfer rates in sensitivity analysis (see below). ...
Background: Malaria remains a major public health problem. While globally malaria mortality affects predominantly young children, clinical malaria affects all age groups throughout life. Malaria not only threatens health but also child education and adult productivity while burdening government budgets and economic development. Increased investments in malaria control can contribute to reduce this burden but have an opportunity cost for the economy. Quantifying the net economic value of investing in malaria can encourage political and financial commitment. Methods: We adapted an existing macroeconomic model to simulate the effects of reducing malaria on the gross domestic product of 26 high burden countries while accounting for the opportunity costs of increased investments in malaria. We compared two scenarios differing in their level of malaria investment and associated burden reduction: sustaining malaria control at 2015 intervention coverage levels, time at which coverage levels reached their historic peak and scaling-up coverage to reach the 2030 global burden reduction targets. We incorporated the effects that reduced malaria in children and young adolescents may have on the productivity of working adults and on the future size of the labour force augmented by educational returns, skills, and experience. We calibrated the model using estimates from linked epidemiologic and costing models on these same scenarios and from published country-specific macroeconomic data. Results: Scaling-up malaria control could produce a dividend of US$152 billion in the modelled countries, equivalent to 0.17% of total GDP projected over the study period across the 26 countries. Assuming a larger share of malaria investments is paid out from domestic savings, the dividend would be smaller but still significant, ranging between 0.10% and 0.14% of total projected GDP. Annual GDP gains were estimated to increase over time. Lower income and higher burden countries would experience higher gains. Conclusion: Intensified malaria control can produce a multiplied return despite the opportunity cost of greater investments.
... The amount of money spent on the healthcare expenditures is influenced by climate change and damaged natural capital as well as their adverse consequences. Climate change-related healthcare expenditures were investigated by Bosello et al. (2012), Chima et al. (2003), OECD (2015). Healthcare cost projections to 2060 reveal increased demand for health services, mainly/especially in Asia, Brazil, the Middle East and North Africa, whereas demand for health services is expected to decrease in countries such as Canada, Germany and France (OECD, 2015). ...
The spread of coronavirus disease has globally affected all aspects of lives. Its impact on the environment and climate change in particular cannot be over-emphasized. Within a few months of trying to contain the spread of the disease, carbon dioxide emissions across the world decreased drastically to about one billion tons from the recorded 2019 industry and energy emissions of about 37 billion tons. Therefore, the present study utilized secondary high-frequency (quarterly) panel data generated among 40 sub-Saharan African countries and adopted the impulse response function of the panel vector autoregressive model to examine the response of environmental pollution and climate change to coronavirus pandemic. It was found that one standard innovation in environmental pollution and climate change produces significant positive effects on the pandemic. The implication of this result is that with a cumulative continuous rise in pandemic cases by one person, with a continuous observance of lockdown and other protocols, environmental pollution and unfavorable climate change would go down and/or improve by half in the next period. However, the impact of a shock on the pandemic today on future environmental pollution and unfavorable climate change decays or reverts to zero fast. The study therefore recommends that people and governments in SSA should strive to continue observing pandemic protocols and reduce environmental pollution.KeywordsCOVID-19PollutionClimate changePandemicGreenhousePanel vector autoregressive
... In addition to its impact on health, malaria imposes a heavy economic burden on individuals [2] and entire economies [3]. In response to calls for widespread control and elimination of malaria and the challenge of meeting the Millennium Development Goals, there has been a rapid scale-up of existing effective anti-malaria interventions, in particular insecticide treated mosquito nets (ITNs) including long-lasting insecticidal nets (LLINs) [4][5][6][7] , coupled with efforts to improve access to prompt and effective treatment [8,9]. ...
Aim: To assess the cost difference of various branded and generic antimalarial drugs available in the Indian market. Material & Methods: The minimum and maximum cost in rupees (INR) of an antimalarial drug manufactured by different pharmaceutical companies in the same dose strength was noted among all the above sources. Results: Highest cost ratio was seen with Chloroquine 500 mg, Mefloquine 250 mg and Sulfadoxine-Pyrimethamine 500+25 mg. Lowest cost ratio was seen with Quinine 600 mg, Chloroquine 250 mg and Sulfadoxine-Pyrimethamine 750+37.5 mg. Conclusion: This study reveals the need to further improve the drug price regulatory mechanism concerning anti-malarial available in India to improve patient compliance and thus cure rates of malaria.
... Despite being a largely preventable and treatable disease, malaria is responsible for an estimated 800,000 deaths globally each year (WHO 2010), with the majority of morbidity and mortality occurring in young children in sub-Saharan Africa. In addition to its impact on health, malaria imposes a heavy economic burden on individuals (Chima et al 2003) and entire economies (Sachs and Malaney, 2002). ...
Malaria poses risk for 97% of Nigeria's population while the remaining 3% of the population live in the malaria free highlands. The Federal Ministry of Health estimated financial loss due malaria and put it at ₦32 Billion per annum with the largest share from the northern geopolitical zone. This figure is particularly huge for a region where poverty stare her people at face. Hence, the financial burden of malaria treatment by households in northern Nigeria was investigated. The Harmonized Nigeria Living Standard Survey (HNLSS, 2010) data was used. The direct cost of malaria treatment on individual such as the direct spending on treating malaria and number of work days lost to incapacitation while income loss represents the indirect cost. The study profiled the incidence, estimated the direct and indirect cost of treatment, and compared the financial burden of malaria treatment within the study area. The direct cost of treatment steeps lowest at the rural sector occupied mostly by farmers estimated at ₦311.18 while the non-farm occupation incurred the highest direct cost estimated at ₦1246.11. Similarly, the least direct cost of treatment by sectors was evident in the rural sector estimated at ₦475.73. The number of days and income loss by the sick person and the care-givers were 3.46days and 3.15days respectively while the lowest income loss in these days were valued at ₦1933.86 and ₦2739.20 respectively. The estimated financial burden rose from 1.15% and 1.96%. The study therefore recommended the strengthening of the "Roll Back Malaria Project".
... 3 The treatment of these illnesses can place substantial financial burdens on poorer households. [4][5][6][7][8][9][10][11] These costs to patients can include both indirect costs such as productivity losses and direct costs such as those related to prevention, diagnosis and treatment. 6 11 A significant proportion of the direct costs of treatment are from spending on medications. ...
Objectives
To examine how drug shop clients’ expenditures are affected by subsidies for malaria diagnostic testing and for malaria treatment, and also to examine how expenditures vary by clients’ malaria test result and by the number of medications they purchased.
Design
Secondary cross-sectional analysis of survey responses from a randomised controlled trial.
Setting
The study was conducted in twelve private drug shops in Western Kenya.
Participants
We surveyed 836 clients who visited the drug shops between March 2018 and October 2019 for a malaria-like illness. This included children >1 year of age if they were physically present and accompanied by a parent or legal guardian.
Interventions
Subsidies for malaria diagnostic testing and for malaria treatment (conditional on a positive malaria test result).
Primary and secondary outcome measures
Expenditures at the drug shop in Kenya shillings (Ksh).
Results
Clients who were randomised to a 50% subsidy for malaria rapid diagnostic tests (RDTs) spent approximately Ksh23 less than those who were randomised to no RDT subsidy (95% CI (−34.6 to −10.7), p=0.002), which corresponds approximately to the value of the subsidy (Ksh20). However, clients randomised to receive free treatment (artemisinin combination therapies (ACTs)) if they tested positive for malaria had similar spending levels as those randomised to a 67% ACT subsidy conditional on a positive test. Expenditures were also similar by test result, however, those who tested positive for malaria bought more medications than those who tested negative for malaria while spending approximately Ksh15 less per medication (95% CI (−34.7 to 3.6), p=0.102).
Conclusions
Our results suggest that subsidies for diagnostic health products may result in larger household savings than subsidies on curative health products. A better understanding of how people adjust their behaviours and expenditures in response to subsidies could improve the design and implementation of subsidies for health products.
Trial registration number
NCT03810014 .
... Third, we were unable to value the time costs (minutes) into monetary values because of the lack of income data from our sample. There is also considerable variation in measuring and valuing time lost into monetary terms, in some cases varies by age, gender, location or economic activity [10,89]. Our sample also combined different service types which limits the process of valuing time lost. ...
Background
Direct and time costs of accessing and using health care may limit health care access, affect welfare loss, and lead to catastrophic spending especially among poorest households. To date, limited attention has been given to time and transport costs and how these costs are distributed across patients, facility and service types especially in poor settings. We aimed to fill this knowledge gap.
Methods
We used data from 1407 patients in 150 facilities in Tanzania. Data were collected in January 2012 through patient exit-interviews. All costs were disaggregated across patients, facility and service types. Data were analysed descriptively by using means, medians and equity measures like equity gap, ratio and concentration index.
Results
71% of patients, especially the poorest and rural patients, accessed care on foot. The average travel time and cost were 30 minutes and 0.41USD respectively. The average waiting time and consultation time were 47 min and 13 min respectively. The average medical cost was 0.23 USD but only18% of patients paid for health care. The poorest and rural patients faced substantial time burden to access health care (travel and waiting) but incurred less transport and medical costs compared to their counterparts. The consultation time was similar across patients. Patients spent more time travelling to public facilities and dispensaries while incurring less transport cost than accessing other facility types, but waiting and consultation time was similar across facility types. Patients paid less amount in public than in private facilities. Postnatal care and vaccination clients spent less waiting and consultation time and paid less medical cost than antenatal care clients.
Conclusions
Our findings reinforce the need for a greater investment in primary health care to reduce access barriers and cost burdens especially among the worse-offs. Facility’s construction and renovation and increased supply of healthcare workers and medical commodities are potential initiatives to consider. Other initiatives may need a multi-sectoral collaboration.
... We calculated productivity losses using three scenarios based on (1) self-reported wage losses, (2) minimum wage per day for all workers between 14 and 50 years of age (the legal minimum and old-age pension eligibility age 18 ) who did not report wage losses and (3) minimum wage per day for all patients >5 years of age who did not report wage losses, given evidence from Africa that children are often involved in economic activities that add to a family's income. 19 In all scenarios, if patients and/or caregivers reported wage losses, these were calculated based on self-reported daily lost productivity (half or full days of work lost due to taking care of the ill patient) and daily wages. For patients and caregivers who did not report wage losses (ie, scenarios 2 and 3), we applied the minimum wage of 1346. ...
Introduction
Cholera remains a significant contributor to diarrhoeal illness, especially in sub-Saharan Africa. Few studies have estimated the cost of illness (COI) of cholera in Malawi, a cholera-endemic country. The present study estimated the COI of cholera in Nsanje, southern Malawi, as part of the Cholera Surveillance in Malawi (CSIMA) programme following a mass cholera vaccination campaign in 2015.
Methods
Patients ≥12 months of age who were recruited as part of CSIMA were invited to participate in the COI survey. The COI tool captured household components of economic burden, including direct medical and non-medical costs, and indirect lost productivity costs.
Results
Between April 2016 and March 2020, 40 cholera cases were enrolled in the study, all of whom participated in the COI survey. Only two patients had any direct medical costs and five patients reported lost wages due to illness. The COI per patient was US$14.34 (in 2020), more than half of which was from direct non-medical costs from food, water, and transportation to the health centre.
Conclusion
For the majority of Malawians who struggle to subsist on less than US$2 a day, the COI of cholera represents a significant cost burden to families. While cholera treatment is provided for free in government-run health centres, additional investments in cholera control and prevention at the community level and financial support beyond direct medical costs may be necessary to alleviate the economic burden of cholera on households in southern Malawi.
... Smith et al. (2013) elaborate on the benefits of malaria eradication for countries when other countries do not follow such a strategy and show that disease eradication can nevertheless be successful and lasting. For the problems that emerge when using the COI approach to estimate the burden of malaria, see Chima, Goodman, and Mills (2003). ...
We discuss and review literature on the macroeconomic effects of epidemics and pandemics since the late twentieth century. First, we cover the role of health in driving economic growth and well-being and discuss standard frameworks for assessing the economic burden of infectious diseases. Second, we sketch a general theoretical framework to evaluate the trade-offs policy makers must consider when addressing infectious diseases and their macroeconomic repercussions. In so doing, we emphasize the dependence of economic consequences on (i) disease characteristics; (ii) inequalities among individuals in terms of susceptibility, preferences, and income; and (iii) cross-country heterogeneities in terms of their institutional and macroeconomic environments. Third, we study pharmaceutical and nonpharmaceutical policies aimed at mitigating and preventing infectious diseases and their macroeconomic repercussions. Fourth, we discuss the health toll and economic impacts of five infectious diseases: HIV/AIDS, malaria, tuberculosis, influenza, and COVID-19. Although major epidemics and pandemics can take an enormous human toll and impose a staggering economic burden, early and targeted health and economic policy interventions can often mitigate both to a substantial degree. (JEL E20, H50, I12, I14, I15, I18, J17)
... Third, we were unable to value the time costs (minutes) into monetary values because of unreliable income or wage rate data for rural and urban population. There is also considerable variation in measuring and valuing time lost into monetary terms, in some cases varies by age, gender, location or economic activity (Chima et al. 2003;McIntyre et al. 2006). Our sample also combined different service types which limits the process of valuing time lost. ...
Background: Direct and time costs of accessing and using health care may limit health care access, affect welfare loss, and lead to catastrophic spending especially among poorest households. To date, limited attention has been given to time and transport costs and how these costs are distributed across patients, facility and service types especially in poor settings. We aimed to fill this knowledge gap.
Methods: We used data from 1407 patients in 150 facilities in Tanzania. Data were collected in January 2012 through patient exit-interviews. All costs were disaggregated across patients, facility and service types. Data were analysed descriptively by using means, medians and equity measures like equity gap, ratio and concentration index.
Results: 71% of patients, especially the poorest and rural patients, accessed care on foot. The average travel time and cost were 30 minutes and 0.41USD respectively. The average waiting time and consultation time were 47 minutes and 13 minutes respectively. The average medical cost was 0.23 USD but only18% of patients paid for health care. The poorest and rural patients faced substantial time burden to access health care (travel and waiting) but incurred less transport and medical costs compared to their counterparts. The consultation time was almost similar across patients. Patients spent more time travelling to public facilities and dispensaries while incurring less transport cost than accessing other facility types, but waiting and consultation time was almost similar across facility types. Patients spent more time travelling to public facilities and dispensaries with less transport cost than accessing other facility types. Patients paid less amount in public than in private facilities. Postnatal care and vaccination clients spent less waiting and consultation time and paid less medical cost than antenatal care clients.
Conclusions: Our findings reinforce the need for a greater investment in primary health care to reduce access barriers and cost burdens especially among the worse-offs. Facility’s construction and renovation and increased supply of healthcare workers and medical commodities are potential initiatives to consider. Other initiatives may need a multi-sectoral collaboration.
... Most common and dreadful complication is cerebral malaria. 5 Although any one can acquire the disease but children are more at risk especially for Plasmodium Falciparum Malaria (PF). Progression to complicated and severe malaria can occur not only with Plasmodium Falciparum Malaria but also with Plasmodium Vivax (PV).In a significant percentage of cases, PV being the most prevalent type. ...
Cerebral malaria is a disease entity which we commonly come across and that itshould be suspected in every patient with impairment of conscious level and high spiking feverespecially with no history of trauma. Early treatment is crucial and can be lifesaving. There aretwo treatment option in which one is conventional Quinine Dihydrochloride and other artmisinininfusion. Objectives: To study the outcomes of Quinine dihydrochloride and artemisininpractice in patients with cerebral malaria in terms of acceptance and response. Study Design:Descriptive cohort study. Place and Duration of Study: Department of Medicine, Unit. II,Jinnah Postgraduate Medical Centre (JPMC), Karachi from January1st2015 to December 31st,2015. Methodology: A total of 78 patients fulfilled the inclusion criteria of Glasgow Coma scale(GCS) were of less than 6 for more than 6 hours Defervescence time were 2 to 3 hours afterstart of treatment Strength of our study is that patients traditional prompt response, with comamulti-organ dysfunction tends to recover and discharge in 4 days. Result: There were total of78 patient. Out of them 32 (41.0%) were positive for Malaria with 29 (37.1%) were positive forPlasmodium Falciparum and 3 were having Plasmodium Vivax .all were offered treatment with57 (73.0%) were given Quinine infusion and 21 (26.94%) were treated with artemisinin infusion.Cure rate was 44 (56.4%) with 46 (58.9%) in quinine group and 14 (17.9%) artemisinin group and(19.2%) and 07 (8.9%) respectively making total mortality of 18 (23.0%). There were 9 (11.5%)patients who left against the medical advice. Average age was 26 ±, majority were male. Inaddition laboratory derangements like alanine amino transferases (ALT), bilirubin, creatinine,electrolytes as potassium and arterial blood gases(ABGs) were also considered. It has beenestimated that recovery time of patients was maximum of 72 hours (time of discharge) for bothartimisinin and Quinine dihydrochloride. Late responders were also observed. Occasionallypersistent of treatment is needed with no fear of drugs resistance. Conclusion: Quinine infusionis generally safe and effective conventional treatment option, whose benefits and acceptance iswell known and we are also documenting this.
... Ninety-three percent of total cases and 94% of global deaths occurred in Africa in 2018 1 . Hence malaria has serious socio-economic impacts and can hamper development over the African continent 3 . Historically, the prevalence of malaria was significantly higher than today, even in temperate regions of Europe and North America 4 , before large control measures were undertaken following World War II 5 . ...
Studies about the impact of future climate change on diseases have mostly focused on standard Representative Concentration Pathway climate change scenarios. These scenarios do not account for the non-linear dynamics of the climate system. A rapid ice-sheet melting could occur, impacting climate and consequently societies. Here, we investigate the additional impact of a rapid ice-sheet melting of Greenland on climate and malaria transmission in Africa using several malaria models driven by Institute Pierre Simon Laplace climate simulations. Results reveal that our melting scenario could moderate the simulated increase in malaria risk over East Africa, due to cooling and drying effects, cause a largest decrease in malaria transmission risk over West Africa and drive malaria emergence in southern Africa associated with a significant southward shift of the African rain-belt. We argue that the effect of such ice-sheet melting should be investigated further in future public health and agriculture
climate change risk assessments.
... Zeolite can be particularly useful to prevent ammonia accumulation in medium-or small-scale rearing facilities constrained by space or water, allowing the rearing of anopheline mosquitoes at higher densities. This may be relevant to the often overcrowded insectaries of smaller research institutions and infrastructures in malaria-endemic countries with low GDIs (gross domestic income) in arid regions [4,44,45]. ...
Background
Malaria vector control approaches that rely on mosquito releases such as the sterile insect technique (SIT) and suppression or replacement strategies relying on genetically modified mosquitoes (GMM) depend on effective mass production of Anopheles mosquitoes. Anophelines typically require relatively clean larval rearing water, and water management techniques that minimise toxic ammonia are key to achieving optimal rearing conditions in small and large rearing facilities. Zeolites are extensively used in closed-system fish aquaculture to improve water quality and reduce water consumption, thanks to their selective adsorption of ammonia and toxic heavy metals. The many advantages of zeolites include low cost, abundance in many parts of the world and environmental friendliness. However, so far, their potential benefit for mosquito rearing has not been evaluated.
Methods
This study evaluated the independent effects of zeolite and daily water changes (to simulate a continuous flow system) on the rearing of An. coluzzii under two feed regimes (powder and slurry feed) and larval densities (200 and 400 larvae per tray). The duration of larval development, adult emergence success and phenotypic quality (body size) were recorded to assess the impact of water treatments on mosquito numbers, phenotypic quality and identification of optimal feeding regimes and larval density for the use of zeolite.
Results
Overall, mosquito emergence, duration of development and adult phenotypic quality were significantly better in treatments with daily water changes. In treatments without daily water changes, zeolite significantly improved water quality at the lower larval rearing density, resulting in higher mosquito emergence and shorter development time. At the lower larval rearing density, the adult phenotypic quality did not significantly differ between zeolite treatment without water changes and those with daily changes.
Conclusions
These results suggest that treating rearing water with zeolite can improve mosquito production in smaller facilities. Zeolite could also offer cost-effective and environmentally friendly solutions for water recycling management systems in larger production facilities. Further studies are needed to optimise and assess the costs and benefits of such applications to Anopheles gambiae (s.l.) mosquito-rearing programmes.
Graphic abstract
... Gertler and Gruber, 2002). The fact that a large share of adults is infected or at risk of infection during a short period of time of an epidemic outbreak limits the ability of communities to accommodate the consequences of (e.g., lost hours of work, estimates of value of lost production or willingness to pay to avoid infections), but the predicted losses are substantial, even in the most conservative scenarios, see, e.g., Chima et al. (2003) for a survey and the final report of the committee on the economics of antimalarial drugs, Arrow et al. (2004, Ch. 7). 10 For instance, "When people are too sick to work [...] there are economic consequences: wage earners are paid less; agriculturists may produce less (particularly if illness coincides with the harvest)" (Arrow at al., 2004, Ch. 7). A "brief period of illness [...] that coincides with the harvest may result in catastrophic effects" (UN Millenium Project, 2005). ...
This paper presents the first systematic investigation of the effect of epidemic shocks on civil violence. The identification exploits exogenous within cell×year variation in conditions that are suitable for malaria transmission using a panel database with month-by-month variation at a resolution of 1° × 1° latitude/longitude for Africa. Suitable conditions increase civil violence in areas with populations susceptible to epidemic outbreaks. The effect is immediate, related to the acute phase of the epidemic, and largest during short harvesting seasons of subsistence crops. Genetic immunities and anti-malaria policies attenuate the effect. The results deliver new insights for prevention and attenuation policies and for potential consequences of climate change.
... Despite lower levels of private healthcare utilization, the households in the poorest quintile faced equal or higher levels of CHE compared with households in the richest quintile ( Figure 2). Similar findings have been observed in other studies (Chima et al., 2003;Sarker et al., 2013). ...
Background:
Diarrhea is a leading cause of morbidity and mortality among the under-five children in Bangladesh. Hospitalization for diarrhea can pose a significant burden to the households and health-systems. We aim to estimate the cost-of-illness due to diarrhea from the healthcare facility, caregiver, and societal perspectives in Bangladesh.
Method:
A cross-sectional study with an ingredient-based costing approach was conducted in 48-healthcare facilities in Bangladesh. In total, 899 caregivers of children under-five with diarrhea were interviewed between August 2017 and May 2018 at discharge and 7-14 days after discharge by phone to capture all expenses and time costs related to the entire episode of diarrhea.
Results:
The average cost per episode for caregivers was US$62 with $29 direct and $34 indirect costs. From the societal perspective, an episode of diarrhea costed an average of $71. In 2018, an estimated $79 million economic costs incurred for treating diarrhea in Bangladesh. Over 46% of interviewed households faced catastrophic expenditure from diarrheal disease.
Conclusion:
The economic costs incurred by caregivers for treating per-episode of diarrhea was around 4% of the annual national gross domestic product per-capita. Investment in vaccination can help to reduce the prevalence of diarrheal diseases and avert this public health burden.
... Zeolite can be particularly useful to prevent ammonia accumulation in medium or small scale rearing facilities constrained by space or water, allowing the rearing of anopheline mosquitoes at higher densities. This may be relevant to the often overcrowded insectaries of smaller research institutions and infrastructures in malaria-endemic countries with low GDIs (Gross Domestic Income) in arid regions [4,42,43]. ...
Background
Malaria vector control approaches that rely on mosquito releases such as the sterile insect technique (SIT) and suppression or replacement strategies relying on genetically modified mosquitoes (GMM) depend on effective mass production of Anopheles mosquitoes. Anophelines typically require relatively clean larval rearing water, and water management techniques that minimise toxic ammonia are key to achieving optimal rearing conditions in small and large rearing facilities. Zeolites are extensively used in closed-system fish aquaculture to improve water quality and reduce water consumption, thanks to their selective adsorption of ammonia and toxic heavy metals. The many advantages of zeolites include low cost, abundance in many parts of the world and environmental friendliness. However, so far, their potential benefit for mosquito rearing has not been evaluated.
Methods
This study evaluated the independent effects of zeolite and daily water changes (to simulate a continuous flow system) on the rearing of An. coluzzii under two feed regimes (powder or slurry feed) and larval densities (200 and 400 larvae per tray). The duration of larval development, adult emergence success and phenotypic quality (body size) were recorded to assess the impact of water treatments on mosquito numbers, phenotypic quality and identification of optimal feeding regimes and larval density for the use of zeolite.
Results
Overall, mosquito emergence, duration of development and adult phenotypic quality was significantly better in treatments with daily water changes. In treatments without daily water changes, zeolite significantly improved water quality at the lower larval rearing density, resulting in higher mosquito emergence and shorter development time. At the lower larval rearing density, the adult phenotypic quality did not significantly differ between zeolite treatment without water changes and those with daily changes.
Conclusions
These results suggest that treating rearing water with zeolite can improve mosquito production in smaller facilities. Zeolite could also offer cost-effective and environmental-friendly solutions for water recycling management systems in larger production facilities. Further studies are needed to optimise and assess the costs and benefits of such applications to Anopheles gambiae s.l. mosquito rearing programmes.
... At an average ammonia adsorption capacity of 25 mg NH 4 + /g of zeolite [18] and simple provision for reuse of zeolitic materials (zeolite embedded bio lters), it might be more economically viable to consider using zeolite to treat water before reuse instead of the more expensive UF or RO methods [4,12]. This could be especially important for mass rearing facilities in malaria-endemic countries with very low GDIs (Gross Domestic Income) and also in arid regions [4,16,45]. Following saturation, zeolitic materials can be recharged by soaking in a 10% NaCl solution, thus renewing their capacity and can subsequently be reused [20,21,46]. ...
Background
Vector control approaches that rely on mosquito releases such as the sterile insect technique (SIT) and suppression or replacement strategies relying on genetically modified mosquitoes (GMM) depend on effective mass production of Anopheles mosquitoes. For optimal development, Anophelines typically require relatively clean water which can be in short supply in some settings. Water replacement requires complex and onerous continuous-flow-systems and/or expensive water filtration systems like ultrafiltration and reverse osmosis. Thus, there is a need for simple cost-effective water management and treatment solutions. Zeolites are additives that have been extensively applied in fish and crustacean aquaculture to improve water quality because of their selective adsorption of ammonia and toxic heavy metals. The many advantages of zeolites include low cost, abundance in many parts of the world and their environmental friendliness, but so far they have not been exploited for mosquito rearing.
Methods
This study evaluated the independent effects of zeolite and daily water changes (to simulate a continuous flow system) on the rearing of An. coluzzii under two feed regimes (powder or solution feed) and larval densities (200 and 400 larvae per tray). The duration of larval development, adult emergence success and phenotypic quality (body size) were recorded to assess the impact of water treatments on mosquito numbers and phenotypic quality and to identify the optimal feeding regimes and density for zeolite use.
Results
Overall, mosquito emergence, duration of development and adult phenotypic quality was significantly better in treatments with daily water changes. In treatments without daily water changes, zeolite significantly improved water quality at the lower larval rearing density, resulting in higher mosquito emergence. Duration of development was significantly longer in zeolite treatments. At the lower larval rearing density, adult phenotypic quality did not significantly differ between zeolite treatment without water changes and those with daily changes.
Conclusions
These results suggest that treating rearing water with zeolite can improve mosquito production under some conditions, and thus offer a cheaper alternative to more expensive techniques such as ultrafiltration or reverse osmosis, which are often part of continuous water change systems. Further studies are needed to optimize its uses for rearing Anopheles gambiae s.l.
... This study focused on pregnant women in Rivers State, which is in the forest zone. The forest zone covers mainly the southern states in Nigeria, including the South-west, South-east and the South-south [2] [3]. ...
... Despite being a largely preventable and treatable disease, malaria is responsible for an estimated 800,000 deaths globally each year (WHO 2010), with the majority of morbidity and mortality occurring in young children in sub-Saharan Africa. In addition to its impact on health, malaria imposes a heavy economic burden on individuals (Chima et al 2003) and entire economies (Sachs and Malaney, 2002). ...
Malaria poses risk for 97% of Nigeria's population while the remaining 3% of the population live in the malaria free highlands. The Federal Ministry of Health estimated financial loss due malaria and put it at ₦32 Billion per annum with the largest share from the northern geopolitical zone. This figure is particularly huge for a region where poverty stare her people at face. Hence, the financial burden of malaria treatment by households in northern Nigeria was investigated. The Harmonized Nigeria Living Standard Survey (HNLSS, 2010) data was used. The direct cost of malaria treatment on individual such as the direct spending on treating malaria and number of work days lost to incapacitation while income loss represents the indirect cost. The study profiled the incidence, estimated the direct and indirect cost of treatment, and compared the financial burden of malaria treatment within the study area. The direct cost of treatment steeps lowest at the rural sector occupied mostly by farmers estimated at ₦311.18 while the non-farm occupation incurred the highest direct cost estimated at ₦1246.11. Similarly, the least direct cost of treatment by sectors was evident in the rural sector estimated at ₦475.73. The number of days and income loss by the sick person and the care-givers were 3.46days and 3.15days respectively while the lowest income loss in these days were valued at ₦1933.86 and ₦2739.20 respectively. The estimated financial burden rose from 1.15% and 1.96%. The study therefore recommended the strengthening of the "Roll Back Malaria Project".
... Evidence suggests that in addition to the implications on the total size of the economy, malaria is associated with reduced labor productivity and supply. [31][32][33][34][35][36][37] To explore this further, we use a common approach in macro-econometric modeling recently applied to the health sector to quantify the argument that malaria case incidence affects economic growth through labor productivity. 38,39 MATERIAL AND METHODS Methods. ...
A portion of the economics literature has long debated about the relative importance of historical, institutional, geographical, and health determinants of economic growth. In 2001, Gallup and Sachs quantified the association between malaria and the level and growth of per capita income over the period 1965-1995 in a cross-country regression framework. We took a contemporary look at Gallup and Sachs' seminal work in the context of significant progress in malaria control achieved globally since 2000. Focusing on the period 2000-2017, we used the latest data available on malaria case incidence and other determinants of economic growth, as well as macro-econometric methods that are now the professional norm. In our preferred specification using a fixed-effects model, a 10% decrease in malaria incidence was associated with an increase in income per capita of nearly 0.3% on average and a 0.11 percentage point faster per capita growth per annum. Greater average income gains were expected among higher burden countries and those with lower income. Growth of industries with the same level of labor intensity was found to be significantly slower in countries with higher malaria incidence. To analyze the causal impact of malaria on economic outcomes, we used malaria treatment failure and pyrethroid-only insecticide resistance as exogeneous instruments in two-stage least squares estimations. Despite several methodological challenges, as expected in these types of analyses, our findings confirm the intrinsic link between malaria and economic growth and underscore the importance of malaria control in the agenda for sustainable development.
Infant mortality rates remain high in many African countries, despite global lowering trends. These high rates are alarming, therefore, this study attempt to examine the effect of malaria and poverty on infant mortality a proxy for child health in Nigeria using a data for the period 1990-2021. Auto-regressive distributed lag model (ARDL) was used as the estimation technique. The study's findings showed that both in the short and long run, poverty rate has a negative non-significant effect on infant mortality while malaria has a positive and significant effect on infant mortality. Government expenditure on health both in the short run and long run is positive and nonsignificant on child health. The current values of primary school enrolment (PSE) and number of physician (NOP) have a negative (-0.014 and -0.0002) non-significant effect on infant mortality in the short, and also negative (-0.501 and -1.654) but significant in the long run. The study recommends that policies that will improve child health and promote poverty reduction should be put in place and well implemented in Nigeria. Also, the government should take measures that will eradicate malaria in Nigeria.
The aim of this article is to Explore Barriers and Resistance in the Adoption of Cryptocurrency among Micro, Small, and Medium Enterprises MSMEs in Zambia’s capital city, Lusaka. When considering the benefits of innovation, one of the trickiest questions to answer is how quickly people will adopt new technologies. This article delves into what motivates and what holds back potential business entities in the MSMEs sector from making a transition to blockchain-based cryptocurrencies like bitcoin. Our findings are narrowly focused on these impediments to adoption, which we identify as Lack of regulatory support, risk of revealing personal data system complexity, lack of regulatory authority, trust deficit, and value speculation.
A review of a selected theories that influence the adoption of technology will serve as the objective of this paper. In this work, we attempt to discover traits that might improve the possibility of acceptance and ongoing usage of technology such as cryptocurrency adoption. More specifically, we focused on Rogers' Innovation Diffusion Theory (IDT, Theory of Technology Acceptance (TAT), and Technology Acceptance Model. (TAM)/TAM2/TAM3, Theory of Reasoned Action (TRA), Unified Theory of Acceptance and Use of Technology (UTAUT), and Theory of Planned Behaviour (TPB). When researching the tendency of individuals to adopt certain technologies, researchers draw from a wide variety of conceptual frameworks and analytical approaches. In this review, social psychology and its applied notions have been utilised most frequently. As a primary theoretical foundation, the theories centre on people's intentions to engage in a specific behaviour (i.e., adopt and utilise ICT), which is the emphasis of the theories. Research on the adoption and usage of information and communication technologies has made extensive use of both the Theory of Reasoned Action (TRA) and the Theory of Planned Behaviour (TPB). They are two of the key intention-based theories, which means they give the core theoretical underpinnings for other adoption theories, such as the Technology Acceptance Model (TAM) and the Enhanced Technology Acceptance Model. Both the transpersonal relationship analysis and the transpersonal behaviour analysis begin with the fundamental premise that individuals deliberately choose whether or not they will engage in a certain behaviour. In this sense, the adoption and usage intentions are typically seen of as a primary outcome variable that is influenced by a variety of independent variables. This is because of the way that they are typically studied. In the following, we will discuss significant theories regarding the adoption of technology.
Like many other developing nations, micro, small and medium enterprises (MSMEs) in Lusaka Zambia have not been spared by the fast pace of technology transfer. Adoption of cryptocurrency has been a huge challenge. The digital currency market is in its infancy, which contributes to its high degree of volatility and risk and poor understanding of its use by several sector players. By the end of the year 2020, a new bull run had begun, and the prices of a number of cryptocurrencies had reached all-time highs. In addition to the progressive acceptance and adoption of cryptocurrencies by individuals all over the world, some of the elements that are contributing to the rise of cryptocurrencies include global increase in the rate of inflation. This Survey analysed data from MSMEs domiciled in Lusaka to understand what would motivate them to adopt cryptocurrency. The major drivers were technological awareness, education, facilitating business environment, behavioural intent, social media, performance and effort expectancy.
Environmental pollution has started to affect and threaten human health. Cost of not investing in the conservation capital includes environmental pollution and climate change. These costs or adverse consequences have their domino effects hindering sustainable development and harming human health. Not investing in the conservation capital or not effective investments in the conservation capital can cause increase in the healthcare expenses of countries hindering their development and harming well-being and welfare of their people. There is a need for effective conservation capital investment and policies to reduce healthcare expenses and support global sustainable development. Based on an in-depth literature review, this chapter aims to investigate the relationship between conservation capital investment and healthcare expenses as well as between conservation capital policies and healthcare policies. Furthermore, the impacts of healthcare expenses on sustainable development of the countries will be examined. Recommendations will be provided for enhancing the effectiveness of conservation capital and policies in reducing healthcare expenses of countries. Researchers, academics and policy-makers are expected to get benefit from this chapter.KeywordsHealthcare policiesHealthcare expensesConservation capital policiesConservation capital investments
Globally, there have been attempts towards improving the coverage of malaria preventive measures with the 2015 goal of the World Health Organization's (WHO's) Roll Back Malaria Partnership centered to reduce global malaria cases by 75% and to reduce malaria deaths to near zero through universal coverage by effective prevention and treatment interventions. Regrettably, malaria still constitutes a serious public health problem in Nigeria. The aim of this study was to assess long lasting insecticide treated net use among women of child bearing age in Nwangele LGA Imo State. A community based descriptive cross sectional study was used for the study. The study involved women of child bearing age aged 15-45yrs at Nwangele LGA as its Target Population. A Probability based multi stage sampling method was Abstract-Globally, there have been attempts towards improving the coverage of malaria preventive measures with the 2015 goal of the World Health Organization's (WHO's) Roll Back Malaria Partnership centered to reduce global malaria cases by 75% and to reduce malaria deaths to near zero through universal coverage by effective prevention and treatment interventions. Regrettably, malaria still constitutes a serious public health problem in Nigeria. The aim of this study was to assess long lasting insecticide treated net use among women of child bearing age in Nwangele LGA Imo State. A community based descriptive cross sectional study was used for the study. The study involved women of child bearing age aged 15-45yrs at Nwangele LGA as its Target Population. A Probability based multi stage sampling method was adopted for the study. A semi-structured questionnaire was used as the instrument of data collection for this study and Statistical Package for the Social Sciences (SPSS) was used in the analysis of the data gotten from the study. A total of 404 women participated in the study. Results from the study revealed that majority 41.5% (169) of the women were aged between 26-30 years. The study showed that a majority of the respondents with 96.5% (390) are aware and have had heard about malaria prior to the study. The study posited that 74.0% (299) of the participants had knowledge of long lasting insecticide treated nets. Further results of the study showed that 74.0% (299) of the participants had knowledge of long lasting insecticide treated nets. 48.0% (194) agreed towards distribution of LLITNs in the community. Based on the Level of Utilization of Long Lasting Insecticide-Treated Nets among the women, the study revealed that 44.3% (179) of the women said yes when asked if they had ever slept under an LLITN. Considering the association demographic characteristics and utilization of LLITNs the study found that marital status (p=0.004), level of education (p=0.0001) and income level
The Malaria in Melbourne 2021 conference was held online in October. This conference aims to provide a platform for students and early career researchers to share their research and develop new collaborative networks. The program covered a broad range of topics including antimalarial drug development, epidemiology, immunology, molecular and cellular biology, and other emerging technologies. This article summarises recent advances in Plasmodium research presented at the Malaria in Melbourne 2021 conference.
Selon le dernier rapport de l’Organisation Mondiale de la Santé (OMS), le paludisme demeure une maladie présentant un fort impact négatif sur la population africaine notamment celle de la Côte d’Ivoire. Au regard du poids sanitaire, économique et financier provoqué par cette maladie, notre étude a été de développer de nouvelles techniques destinées au diagnostic du paludisme en Côte d’Ivoire. Nos contributions dans cette thèse se situent à deux niveaux majeurs que sont la construction d’un système optique et le développement de techniques de traitement d’images ; lesquels combinés a permis la distinction de cellules sanguines infectées de celles non infectées par le paludisme.Dans un premier temps nous avons, à la suite d’un partenariat entre le Laboratoire d’Instrumentation, Image et Spectroscopie (L2IS) et l’université de LUND en Suède, implémenté un nouveau modèle de microscope multispectral et multimodal. Il est une amélioration du microscope optique standard rencontré dans les centres de santé en Côte d’Ivoire. Il est également une amélioration du microscope (multispectral et multimodal) que nous avons trouvé à notre arrivée au L2IS. Le système construit présente la particularité d’être extensible c’est-à-dire pouvant être adapté aux besoins de l’utilisateur tant au niveau des modalités d’imagerie qu’au niveau des sources d’illumination utilisées. Nous l’avons modifié et adapté à notre objectif applicatif qui est le diagnostic du paludisme. A cet effet, nous l’avons équipé de lasers de longueurs d’ondes de 405 nm, 450 nm, 538 nm et 638 nm. Les longueurs d’ondes choisies sont celles étant les plus discriminantes pour le diagnostic du paludisme. Nos expérimentations ont été réalisées en acquérant des images multispectrales en utilisant le système que nous avons construit et également en utilisant le système trouvé au sein du L2IS à notre arrivée (constitué de 13 diodes électroluminescentes allant de 375 nm à 940 nm). Nous obtenons finalement des images multi-composantes constituées d’une part de quatre (4) plans spectraux et d’autre part de treize (13). Dans un deuxième temps, nous avons développé des techniques de traitement d’images pour l’analyse des images produites en utilisant les microscopes multispectraux et multimodaux précédemment cités. Les travaux relatifs au développement de ces techniques de traitement d’images ont été réalisés à la suite d’un partenariat entre le L2IS et le LARIS (Laboratoire Angevin de Recherche en Ingénierie des Systèmes) sis à l’Université d’Angers. Ces travaux reposent sur une analyse de textures multi-composantes basée sur les Local Binary Pattern (LBP). Issus des approches statistiques, le choix des Local Binay Pattern (LBP) pour l’analyse de nos images vis-à-vis des approches fréquentielles, morphologiques et structurelles a été adopté en raison de leur simplicité et de leur robustesse dans la classification de textures. Ils permettent de décrire localement la texture d’une image. Différentes variantes ont été développées afin de les rendre plus robustes : D’une part, celles améliorant la topologie du voisinage, l’échantillonnage du voisinage, le seuillage, la quantification. D’autre part, le regroupement et l’encodage des bits puis enfin la combinaison des méthodes LBP entre elles ou avec d’autres méthodes.
Working‐age patients are generally found to have higher healthcare expenditure than elder. China implemented critical illness insurance (CII) in 2012 to decrease the medical expenditure of patients. The aim of this study was to determine if the economic burden of rural working‐age patients with CII was more serious than other age groups. A questionnaire survey was undertaken in two counties of central and western China in 2017. Comprehensive financial measurement was used, including direct costs, indirect costs and medical debt rate. All data collected were used for descriptive statistics and multivariate variance analysis. Linear regression with random effect analysis upon area was used to evaluate the differences in ages. A total of 834 rural patients were surveyed in this study. Patients aged 18–44 years had the highest lodging and food payments (3,838 Chinese Yuan [CNY]), work loss (15,350 CNY) and medical debt rate (83.24%). Patients who were of working age, sought health services out of counties, had longer length of stay, and were diagnosed with chronic illness had higher healthcare expenditure. Rural working‐age patients with CII had higher direct and indirect costs, which were attributed to medical debt. The increased service capability of hospitals in counties and improved medical financial assistance may also be issues of concern.
Malaria is a mosquito-borne infectious disease caused by Plasmodium spp. It has severely impacted on individual and community productivity, social behavior, urbanization, as well as cultural, political, and economic developments in countries, where it is endemic. Given the high efficacy of major antimalarial drugs in targeting different stages of the parasite life cycle and the access to prophylactic measures, malaria was near to be eradicated. However, the emergence of resistance by parasites towards both curative and preventive drugs, and by mosquitoes to insecticides and traps has reopened the challenge. Natural products are still considered by the global medical researchers as a rich source of new chemical entities for the development of safe, cheap, and sustainable therapeutic agents. Natural products have been the mainstay of antimalarial therapy for thousands of years, and some are used in the traditional medicine by local populations, where malaria is endemic. This chapter updates the recent discoveries in phytochemical remedies that are able to treat malaria at different stages (prevention, recurrence, and therapy) as a result of limitations of synthetic drugs. These active compounds are organized according to their plants and fungi families. This in-depth survey attempts to analyze not only plant extracts, but also their main component’s bioactivity, the mechanism of action, and the potential synergism with other known drugs and side effects. Medicinal chemists can take advantage of such scaffolds to derive semisynthetic compounds with improved pharmacodynamic and pharmacokinetic properties. It is important that the efficacy and safety of traditional medicines must be validated, and their active constituents should be identified to establish reliable structure activity relationships.
A research infrastructure was established in two ecological zones in southern Ghana to study the variables of malaria transmission and provide information to support the country's Malaria Action Plan (MAP) launched in 1992. Residents' beliefs and practices about causes, recognition, treatment and prevention of malaria were explored in two ecological zones in southern Ghana using epidemiological and social research methods. In both communities females constituted more than 80% of caretakers of children 1-9 years and the illiteracy rate was high. Fever and malaria, which are locally called Asra or Atridi, were found to represent the same thing and are used interchangeably. Caretakers were well informed about the major symptoms of malaria, which correspond to the current clinical case definition of malaria. Knowledge about malaria transmission is, however, shrouded in many misconceptions. Though the human dwellings in the study communities conferred no real protection against mosquitoes, bednet usage was low while residents combatted the nuisance of mosquitoes with insecticide sprays, burning of coils and herbs, which they largely considered as temporary measures. Home treatment of malaria combining herbs and over-the-counter drugs and inadequate doses of chloroquine was widespread. There i s a need for a strong educational component to be incorporated into the MAP to correct misconceptions about malaria transmission, appropriate treatment and protection of households. Malaria control policies should recognize the role of home treatment and drug shops in the management of malaria and incorporate them into existing control strategies.
Plasmodium falciparum malaria remains a global public health threat. Optimism that a highly effective malaria vaccine can be developed stems in part from the observation that humans can acquire immunity to malaria through experimental and natural P. falciparum infection. Recent advances in systems immunology could accelerate efforts to unravel the mechanisms of acquired immunity to malaria. Here, we review the tools of systems immunology, their current limitations in the context of human malaria research, and the human 'models' of malaria immunity to which these tools can be applied.
Iron-deficiency anemia has been associated with lowered scores on tests of mental and motor development in infancy. However, the long-term developmental outcome of infants with iron deficiency is unknown, because developmental tests in infancy do not predict later intellectual functioning.
This study is a follow-up evaluation of a group of Costa Rican children whose iron status and treatment were documented in infancy. Eighty-five percent (163) of the 191 children in the original group underwent comprehensive clinical, nutritional, and psychoeducational assessments at five years of age. The developmental test battery consisted of the Wechsler Preschool and Primary Scale of Intelligence, the Spanish version of the Woodcock-Johnson Psycho-Educational Battery, the Beery Developmental Test of Visual-Motor Integration, the Goodenough-Harris Draw-a-Man Test, and the Bruininks-Oseretsky Test of Motor Proficiency.
All the children had excellent hematologic status and growth at five years of age. However, children who had moderately severe iron-deficiency anemia as infants, with hemoglobin levels less than or equal to 100 g per liter, had lower scores on tests of mental and motor functioning at school entry than the rest of the children. Although these children also came from less socioeconomically advantaged homes, their test scores remained significantly lower than those of the other children after we controlled for a comprehensive set of background factors. For example, the mean (+/- SD) adjusted Woodcock-Johnson preschool cluster score for the children who had moderate anemia in infancy (n = 30) was 448.6 +/- 9.7, as compared with 452.9 +/- 9.2 for the rest of the children (n = 133) (P less than 0.01); the adjusted visual-motor integration score was 5.9 +/- 2.1, as compared with 6.7 +/- 2.3 (P less than 0.05).
Children who have iron-deficiency anemia in infancy are at risk for long-lasting developmental disadvantage as compared with their peers with better iron status.
The Malaria Effects on Technical Efficiency of Cotton Growers in Northern Côte d'Ivoire
This article assess the role of malaria on the agricultural development and more precisely on technical efficiency in the context of cotton crop in the Korhogo region in the North of Côte d'Ivoire. The stochastic frontier production function incorporating a model for technical inefficiency effects (Battese and Coelli, 1995) was applied in order to check the hypothesis that the efficiency deviations between farmers should be explained by the disparity of the presence and the severity of malaria infection among the farmers and their family.
Field data was collected by the authors between March 1997 and February 1998 on 700 rural households living in three production systems differently exposed to the malaria risk. Three malaria indicators were used. There were the prevalence, in the active (11-55 years old) family members of the farm, of parasitemia, high and very high densities of Plasmodium falciparum. The results of the model and the distribution of farm efficiency according to the presence and the severity of malaria infection obviously determine a critical threshold above which malaria has a negative effect on technical efficiency in the cotton crop. Then, farm households in which the proportion of actives with a high density of Plasmodium falciparum (more than 499 parasites/pl of blood) was higher or equal to 25 %, were less efficient than the farm households in which this density is lower.
This paper draws on data from Sierra Leone, and secondary data from elsewhere, to show that the rural poor can be disproportionately disadvantaged by user charges for health care, paying a higher percentage of their incomes for health care than wealthier households. Cost sharing systems at primary care level should include exemptions for the poor, but rarely succeed in consistently protecting them. The regressivity of health expenditures also results from lack of protection from the higher costs of less-frequently used, expensive providers. In Sierra Leone, the burden of curative treatment costs for all groups came mainly from private and NGO providers. Proximity to facilities appeared a more important factor in their use than average price levels. Even if a perfect exemption system existed at government primary care facilities, it would not have had much overall effect because of their relatively small contribution to household health expenditures.
This chapter presents evidence that the consequences of adult ill-health are substantial, larger than had been supposed previously, and larger than the consequences of illness in non-adults. The chapter explores the consequences of adult-ill-health on the health of other household members, on medical treatment costs, and on nonmedical consumption, investment, production, earnings, and income distribution. The chapter also addresses the costs of the coping mechanisms that households and communities use to mitigate or to insure against the consequences of adult ill-health. -Authors
To optimize the funds devoted to health care, and to objectively assess the tools used in monitoring patients with cerebral malaria, we determined two parameters, care charges and direct costs due to hospitalization. During this longitudinal study conducted at the Albert Royer Pediatric Hospital in Dakar from October 15, 1991 to October, 15, 1992 with 76 cases, malaria represented 5.2% of the febrile cases and 3.4% of the hospitalized cases. The lethality rate was 3.4%. Clinical features were not correlated with care charges and thus were not good indicators of worker's labor. The average cost of a cerebral malaria hospitalization was estimated at 35,710 F CFA (in October 1992, 1 F CFA = 0.02 FF). This cost is very high depending the limited resources of the region. Rapid and proper treatment of malaria cases may lead to a significant reduction of costs.
Insecticide-impregnated bednets are currently being promoted
as one of the promising malaria control methods in endemic
regions of most developing countries. Although, much is known
about the entomological and epidemiological aspects of treated
bednets, little is known about the efficiency of malaria
control programmes in general, and bednets in particular. This
cost-effectiveness analysis forms part of the evaluation of
the Gambian National Insecticide-impregnated Bednet Programme
(NIBP).
The research was conducted in the rural Gambia where malaria
is endemic. An integrated approach to data collection approach
(qualitative and quantitative) provided information for the
four objectives of the study, namely;
1. to calculate the total NIBP implementation costs (ie'
direct and indirect costs);
2. to estimate the number of child (under 10 years)
deaths averted in the intervention area;
3. to calculate the resources saved by averting a child
death to the health sector and households both
direct (ie saved treatment costs, saved preventive
expenditures, postponed funeral expenses) and
indirect (ie time costs saved by carers and
relatives that can be spent on productive
activities) and subtract these from the programme
costs, to produce net cost-effectiveness ratios and
4. to investigate the effect of impregnated bednets on
primary school attendance in terms of days and
reasons for absenteeism. The study covered 64 government and non-governmental
organization personnel, 179 village dippers, 306 women in
groups of 5 8 in focus group discussions, 25 in-depth
interviews of men, 134 carers of children, 50 women in random
spot observations and 2182 pupils in school attendance study.
The main findings of the study were;
1. The annual implementation cost of NIBP was
D757,874.72.
2. The implementation and the net cost-effectiveness
ratios per child death averted were D4,946.63 and
D1,332.31 respectively and,
3 . Impregnated bednets were observed to reduce
absenteeism due to ill-health.
NIBP was an efficient malaria control method in rural Gambia
and saved resources.
A precise method to estimate the cost of malaria in a rural area was developed and applied in 3 villages in Burkina Faso. The estimate takes into account direct costs such as consultation fees, microscopic examinations, medication and transport as well as indirect costs caused by lost workdays. The formula uses 6 variables: age of subject, degree of invalidity, duration of illness, profession, income and percentage of income lost. In the region of Bobo-Dioulasso, 3065 health centre clients were registered in the course of the study: 17% had been clinically diagnosed as having malaria but this was confirmed microscopically in only 11.6% of cases; 73.1% were children aged < 5 years, 13.9% children aged 6-15 years, 12.2% adults aged 16-50 years and 0.8% adults aged > 50 years. Most patients worked in agriculture and trade. The average duration of illness was 4 days, with each case incurring a cost of $11.7 comprised of $8 direct costs and $3.7 indirect costs.
This article assess the role of malaria on the agricultural development and more precisely on technical efficiency in the context of cotton crop in the Korhogo region in the North of Cote d'ivoire. The stochastic frontier production function incorporating a model for technical inefficiency effects (Battese and Coelli, 1995) was applied in order to check the hypothesis that the efficiency deviations between farmers should be explained by the disparity of the presence and the severity of malaria infection among the farmers and their family. Field data was collected by the authors between March 1997 and February 1998 on 700 rural households living in three production systems differently exposed to the malaria risk. Three malaria indicators were used. There were the prevalence, in the active (11-55 years old) family members of the farm, of parasitemia, high and very high densities of Plasmodium falciparum. The results of the model and the distribution of farm efficiency according to the presence and the severity of malaria infection obviously determine a critical threshold above which malaria has a negative effect on technical efficiency in the cotton crop. Then, farm households in which the proportion of actives with a high density of Plasmodium falciparum (more than 499 parasites/μl of blood) was higher or equal to 25 %, were less efficient than the farm households in which this density is lower.
Two drug strategies for the control of malaria in children aged 3-59 months have been compared in a rural area of The Gambia—treatment of presumptive episodes of clinical malaria with chloroquine by village health workers, and treatment combined with fortnightly chemoprophylaxis with 'Maloprim' (pyrimethamine/dapsone) which was also given by village health workers. Treatment alone did not have any significant effect on mortality or morbidity from malaria. In contrast, treatment and chemoprophylaxis reduced overall mortality in children aged 1-4 years, mortality from probable malaria, and episodes of fever associated with malaria parasitaemia. A high level of compliance with chemoprophylaxis was obtained and no harmful consequences of chemoprophylaxis were observed.
Economic evaluation techniques were originally developed to assess the efficiency of public, rather than private, investment decisions. They are particularly relevant to the health sector where there is general agreement that free markets fail to produce efficient and equitable solutions, and government intervention can improve both equity and efficiency. In this paper, the four evaluation techniques most commonly applied to the health sector—cost-minimization, cost-effectiveness, cost-utility and cost-benefit analysis—are reviewed in turn. The purpose is not to provide a step by step guide to their use. Rather, the aim is to explain the context in which they are used, their relative strengths and weaknesses, and to highlight a number of methodological issues and controversies surrounding their application. The discussion shows that no technique is without problems, and none can be recommended as being better than the others in all situations. The review concludes that, despite the sophistication of the academic debate surrounding the techniques, the type of economic evaluation which will influence health policy must remain pragmatic. For the time being, a full description of the costs and benefits of competing alternatives is likely to be more useful to decision makers than attempts to incorporate all possible costs and benefits into a single efficiency ratio.
Une méthode d'estimation précise du coût des accès palustres en milieu rural a été développée et a été appliquée dans 3 villages de la région de Bobo-Dioulasso au Burkina Faso. Le coût de l'accès palustre comprend le coût direct (coûts de la consultation, de l'examen microscopique, des médicaments et du transport), et le coût indirect (coût des journées de travail perdues). L'intérêt de la formule tient surtout à la méthode d'estimation du coût indirect qui est le plus difficile à mesurer surtout à l'échelle d'une collectivité. Son estimation utilise les variables suivantes: âge du sujet, degré d'invalidité, durée de la maladie, activité professionnelle, revenu économique, pourcentage de perte économique. Ces variables peuvent être mesurées dans chaque zone et la formule appliquée pour obtenir une estimation plus précise du coût de l'accès palustre.
Dans les 3 villages de la région de Bobo-Dioulasso, 3065 consultants ont été enregistrés dans les centres de santé au cours de l'étude. Parmi eux 544 (17,7%) étaient cliniquement diagnostiqués comme paludéens. Mais après l'examen microscopique seuls 353 (11,6%) ont été confirmés parasitologiquement. Ils étaient composés de 73,1%âgés de 0 à 5 ans, 13,9%âgés de 6 à 15 ans, 12,2%âgés de 16 à 50 ans et 0,8%âgés de plus de 50 ans. L'activité professionnelle dominante était l'agriculture puis viennent l'élevage et le commerce.
La durée moyenne d'invaliditéétait de 4 jours. Le coût économique moyen de l'accès palustre était de 11,7 $, soit un coût direct moyen de 8 $ et un coût indirect moyen de 3,7 $.
Existing data suggest that iron deficiency anemia (IDA) is a risk factor for poor educational performance in schoolchildren. The synergistic effect of IDA in combination with other forms of malnutrition and other risk factors may affect educational performance more strongly. Thus, IDA and its effect on educational performance should be studied in the context of other risk factors.
This survey covers recent English-language literature on the inter-relationships between population and development in contemporary developing countries. Part I explores factors affecting mortality and fertility, and stresses the importance of the type of development which may influence population change. Part II examines the effect of population growth on the economy: little support is found for any strong positive or negative relationship between growth of population and that of real output, but it seems clear that at least among poor developing countries a slowing down of population growth must facilitate the growth of per capita output. Questions of food, employment, income distribution, health, education, urban development and some more theoretical issues are also reviewed, as well as suggestions for further research.
Increasing recognition has been given to the fact that in developing countries improved health may make an important contribution to economic development. In analysing this relationship it is important to distinguish between the immediate, stable situation with organizational modes and technology held constant and longer term issues in which organizational and technical change induced by improved health standards must be taken into account.Development policy can be more effectively planned if both levels of analysis are considered.
To calculate the costs at Kilifi District Hospital (KDH) and Malindi Sub-district Hospital (MSH) of treating paediatric malaria admissions including three common presentations of severe paediatric malaria, i.e. cerebral malaria, severe malaria anaemia and malaria-associated seizures; and to estimate the implications for hospital expenditure of a reduction in paediatric malaria admissions.
Patient data were obtained from hospital records. All costs were allocated to departments that provided direct patient care by a four-stage step-down procedure. Laboratory and drug costs of treating paediatric malaria admissions were separately identified.
Unit recurrent costs per admission in KDH ranged from US $57 for 'other' paediatric malaria to US $105 for cerebral malaria, and in MSH from US $33 to US $44 for the same categories. The annual recurrent cost of treating all paediatric malaria admissions to KDH prior to the trial was estimated at US $78 900. Adjusting for preintervention differences in malaria admission rates and age between intervention and control areas, the ITBN trial found a 41% reduction in paediatric malaria admissions. The reduction in admissions resulted in an estimated saving of US $6240 in the cost of treating paediatric malaria admissions from the intervention area.
There would be a substantial reduction in costs of treating paediatric malaria admissions if the intervention were introduced in the whole catchment area of the hospital. Actual savings would depend on the proportion of potential savings that can in practice be realised, and on the effectiveness of the intervention when routinely implemented.
Good health is an integral component of the quality of human life, a prerequisite for developing human potential and an important determinant of economic development. When a person is ill from a tropical disease in an agricultural economy, a complex interaction between the individual's welfare and the family's welfare is set in motion. So complex are these interactions that few empirical studies exist on this subject and even where they do, empirical quantification of these interactions and economic losses places the analyst in the minefield of valuing time, ability and contribution to economic welfare. Placing monetary values on these commodities is always a little unsatisfactory since dollar values do not adequately reflect the nature of the losses. Secondly, the ill person's struggle to minimize the economic effects of disease on family income will mask its true impact; thirdly, tropical diseases disproportionately affect low-income groups and therefore measuring the income effects of disease amongst these groups will only reach at the earnings effect, and underestimate the economic implications of tropical disease control. Despite these difficulties, quantification of the economic impact of disease is important from a public health point of view. This study is an attempt at such a task, and focuses on the intra-familial struggle to minimize economic losses due to malaria. Using a case-control approach, time-losses and labour reallocations within the household are examined in an attempt to understand the economic consequences of the disease. One conclusion is that there is no symmetry between the disease burden and the economic burden; in this study the disease burden was greatest amongst males, but the economic impact of this burden was greatest amongst females who postponed or carried out their own activities in addition to caring for the sick and replacing them in farm production.
A World Bank research publication
Thesis (Ph. D.)--University of Exeter, 1994.
BLDSC reference no.: DX189592. Thesis (doctoral)--University of London, 1989.
For 98 countries in the period 1960–1985, the growth rate of real per capita GDP is positively related to initial human capital
(proxied by 1960 school-enrollment rates) and negatively related to the initial (1960) level of real per capita GDP. Countries
with higher human capital also have lower fertility rates and higher ratios of physical investment to GDP. Growth is inversely
related to the share of government consumption in GDP, but insignificantly related to the share of public investment. Growth
rates are positively related to measures of political stability and inversely related to a proxy for market distortions.
The verbal autopsy (VA) is an epidemiological tool that is widely used to ascribe causes of death by interviewing bereaved relatives of children who were not under medical supervision at the time of death. This technique was assessed by comparison with a prospective survey of 303 childhood deaths at a district hospital in Kenya where medically confirmed diagnoses were available. Common causes of death were detected by VA with specificities greater than 80%. Sensitivity of the VA technique was greater than 75% for measles, neonatal tetanus, malnutrition, and trauma-related deaths; however, malaria, anaemia, acute respiratory-tract infection, gastroenteritis, and meningitis were detected with sensitivities of less than 50%. There may have been unwarranted optimism in the ability of VAs to detect some of the major causes of death, such as malaria, in African children. VA used in malaria-specific intervention trials should be interpreted with caution and only in the light of known sensitivities and specificities.
In order to evaluate the financial charges of antivector control and disease at family level for "malaria disease" as perceived by Yaounde inhabitants, the authors carried out a transverse survey on a representative sample of populations derived from sampling surveys at different degrees. Malaria, so defined, represents a dominating endemic for which the yearly financial effort consented by each family amounts to 57,000 FCFA which represents medical care and entailed services as well as the purchase of chemicals for antivector control. The development of more efficient therapeutic behaviours and promotion of greater use of remanent insecticide impregnated bed nets comes in first in setting up training programmes aimed at health personnels and populations who are under their responsibility.
Insecticide treatment of bed nets ("mosquito nets") may be a cheap and acceptable method of reducing the morbidity and mortality caused by malaria. In a rural area of The Gambia, bed nets in villages participating in a primary health-care (PHC) scheme were treated with permethrin at the beginning of the malaria transmission season. Additionally, children aged 6 months to 5 years were randomised to receive weekly either chemoprophylaxis with maloprim or a placebo throughout the malaria transmission season. We measured mortality in children in PHC villages before and after the interventions described, and compared this with mortality in villages where no interventions occurred (non-PHC villages). About 92% of children in PHC villages slept under insecticide-treated bed nets. In the year before intervention, mortality in children aged 1-4 years was lower in non-PHC villages. After intervention, the overall mortality and mortality attributable to malaria of children aged 1-4 in the intervention villages was 37% and 30%, respectively, of that in the non-PHC villages. Among children who slept under treated nets, we found no evidence of an additional benefit of chemoprophylaxis in preventing deaths. Insecticide-treated bed nets are simple to introduce and can reduce mortality from malaria.
An investigation on the knowledge, behaviour and practices regarding the protection against mosquitoes was carried out in June 1990 among 420 households in six districts of urban Kinshasa. Most of the surveyed families (92.4%) consider mosquitoes as a nuisance and 83.8% say to do something about it. Among the latter, 43.5% spend money for their protection: incense coils (85.6%), insecticide sprays (55.5%), bednets (38.6%). In May 1990, families have spent a median sum of US$ 5.00, which was at that time about the price of an impregnated bednet. 89.5% of the surveyed families said they would agree to buy an impregnated bednet if the price was acceptable (median sum of US$ 4.00 is judged as acceptable). Impregnated bednets being an efficient method of malaria control, financially accessible and acceptable, their utilization should be further encouraged by the national programme of malaria control and primary health care.
Comprehensive estimates of the direct economic costs of malaria should include not only the costs of care at established health facilities, but also other expenditures, such as travel and out-of-pocket costs of drugs. They should include all episodes of illness, whether or not the patient attended a health facility. Also, the indirect economic costs, which are based on the value of time lost due to illness, consider seasonal variations in the marginal product of labor according to the agricultural season. A 1985 representative survey of 626 households in Solenzo medical district, Burkina Faso, provided household data on health service utilization, expenditures, and agricultural production with which to implement these refinements. Numbers of malaria deaths and cases were estimated by adjusting survey totals according to monthly patterns of reported malaria deaths. The marginal product of labor was valued according to typical activities in each of three agricultural seasons: brewing millet beer during the maintenance period (January-February), growing cotton during the cash crop season (March-April), and growing millet and sorghum during the food crop season (May-December). The resulting values were $0.28, $1.09, and $0.55 per day, respectively. Cost per case averaged $5.96 and cost per capita $1.15. Indirect cost due to mortality was the largest cost component ($0.79 per capita), followed by direct costs incurred by the user (e.g. transportation costs and drug purchases, $0.22 per capita). Direct costs paid by providers were small, only $0.04 per capita. A household survey provides the necessary data for more comprehensive population-based estimates of costs of malaria.
Although malaria is widely recognized as a major public health problem in much of Africa, its impact on a specific national or regional economy has proved difficult to assess. This paper demonstrates the kind of analysis possible given available national aggregate statistics on epidemiology and economic indicators, the type of data most readily available. An economic model which applies the average cost of malaria per case to the known number of cases in Rwanda for 1989 estimated the total cost to be $ 2.88 per capita (in 1987 US dollars). Of this cost, $0.63 per capita represents the direct cost of treatment, including care of outpatients and hospitalized cases in both government and private facilities, as well as self-treatment. The other $ 2.25 per capita represents the indirect costs of productive time lost to malaria morbidity in adults and to care for sick children, and the cost of lifetime earnings lost through premature malaria mortality. The average output per day of the Rwandan economy was $0.83 in 1989. Thus, the per capita malaria cost equals 3.5 days of production or 1% of GDP. The average cost of each of the 1,722,271 reported malaria cases in 1989 was $11.82: $2.58 in direct and $9.24 in indirect cost. The direct cost per case is equal to 160% of the per capita budget of the Ministry of Health. Economic and epidemiological projections to 1995 yield an increase in malaria cases to over 4 million at a cost of $7.11 per capita. Direct costs are projected to rise over 200% due to increasing costs of drugs and supplies to treat increasingly drug-resistant cases. Indirect costs, which are tied to a declining economy, are projected to rise by just over 100%. By 1995, malaria is projected to cost 2.4% of the Rwandan GDP, exacerbating an already serious impact.
The World Health Organization does not give any data on the malaria situation in Africa in its regular reports because of the "insufficiency and irregularity of reporting". Estimates on the total number of cases and the number of deaths vary considerably. They range from 35 million to 189 million per year depending on whose figures one uses. An intensive search of the literature using computer-based systems identified more than 1000 titles on the epidemiology of malaria. Out of them and from other sources finally 426 articles were used to describe the current malaria situation and observable trends in Africa. Major findings were that malaria is responsible for about 40% of fever cases, mortality is about 5 per 1000 per year, case fatality ranges from 2% to 24%. Admissions for malaria account for 20% to 50% of all admissions in African health services although only 8% to 25% of persons with malaria visit health services. Self-treatment is more common in urban areas (more than 60%) but an increasing number of people use some form of self protection in rural areas (2% to 25%). The resistance of malaria parasites to chloroquine and other drugs is widespread. Chloroquine resistance has reached a prevalence of about 30% at the RII level in most countries. Malaria incidence shows annual growth rates of 7.3% for Zambia, 10.4% for Togo, and 21.0% for Rwanda. The data for Burkina Faso show a downward trend of--14.7% during the years from 1973 to 1981. Since then malaria incidence is increasing at 11.0% per year. Hospital data reported from Zambia indicate that mortality is rising 5.2% per annum in children and 9.7% per annum in adults. Reasons for the increase of malaria and its role for development are discussed.
Although malaria is the major health problem in Africa, there is little research on its economic impact. This study adapts a framework for assessing the economic costs of illness to available data on malaria. Direct costs of illness are the costs of treatment and control activities, and indirect costs are the value of lost time due to morbidity and premature mortality. Direct costs were estimated by applying the average estimated health systems costs per case to the number of cases. Indirect costs were assessed by multiplying adult output per day times the estimated productive time lost through both adult and childhood cases. As data are not available to assess the economic impact of malaria in Africa as a whole, four case studies were performed on countries or regions for which needed data could be found. The four sites (Rwanda, Solenzo medical district of Burkina Faso, Mayo-Kebbi district, Chad, and Brazzaville, Congo) were chosen to illustrate the diversity in kinds of data which can be used (aggregate national health statistics versus household surveys) and in locations (urban versus rural). Costs were calculated for the recent past and were projected to 1995 based on recent epidemiological trends. Estimates for all sub-Saharan Africa were derived from the averages of these sites. In 1987, a case of malaria cost $9.84 (in 1987 US dollars)--$1.83 in direct costs and $ 8.01 in indirect costs. As the average value of goods and services produced per day in Africa was $0.82, this cost is equivalent to 12 days of output.(ABSTRACT TRUNCATED AT 250 WORDS)
A Knowledge, Attitude, Practice survey was carried out in July 1988 in Douala city, by cluster sampling and household visits. 98% of these households declared being disturbed by mosquitoes (bites, diseases, noise); 91% of families are using a vector control method; the main methods are: bed-nets (48%), insecticide sprays (39.5%) and mosquito coils (36.7%). The average cumulated expense by households for vector control (116.6 ECU/year) and care for diseases attributed to mosquitoes (147.4 ECU/year) was evaluated at the equivalent of about 3 months of "minimum monthly wages". More than 90% of people interviewed would accept buying and using an insecticide impregnated bed-net provided that the price of such a product be lower than the current habitual price for ordinary bed-nets. The distribution of the impregnation technique must be made at the level of impregnation centres, which should start impregnating the existing bed-nets and take care of informing the public.
A trial of malaria chemoprophylaxis given by traditional birth attendants was undertaken in a rural area of The Gambia where
access to antenatal clinics is difficult. Women received one or more doses of Maloprim® or placebo from a traditional birth attendant during 1049 of 1208 pregnancies (87%) recorded in 16 villages over a 3-year
period. Primigravidae who received Maloprim® had a lower parasite rate and a significantly higher mean packed cell volume than primigravidae who received placebo, and
their babies were significantly heavier (6% low birth weight vs 22%). In multigravidae chemoprophylaxis reduced malaria parasitaemia
but it had no beneficial effect on haemoglobin level and much less effect on birth weight than was observed in primigravidae.
However, the mean birth weight of babies bom to grandemultigravidae who received chemoprophylaxis was significantly higher
than that of babies born to grandemultigravidae who did not.
A double-blind clinical trial was conducted in Indonesia to assess effects of iron supplementation on performance of iron-depleted and iron-deficient anemic children in discrimination and oddity learning tasks. Half these children received elemental Fe for 8 wk; the others received a placebo. There were significant changes from pre- to postintervention evaluations in ferritin, transferrin saturation, free erythrocyte protoporphyrin, and hemoglobin among the anemic and iron-depleted children; no changes were observed among the placebos or any of the iron-replete children. The magnitude of hematological changes in anemic children treated with iron was small; yet, after treatment the children's mean ferritin, transferrin saturation, and hemoglobin values were above the cutoff points used for the definition of iron-deficiency anemia (IDA). Pre- and posttreatment psychological test data show that IDA produces alterations in cognitive processes related to visual attention and concept acquisition, alterations reversed with iron treatment.
Within the framework of the preparation (acceptability and feasibility) of an integrated malaria control including insecticide impregnated bednets notably, a Knowledge Attitude Practice survey (home cluster sample) was carried through in March, 1988 in Yaoundé City to identify the current major mosquito behaviour control methods: insecticide sprays, mosquito coils and bednets and the motivations in the use of these control methods. The cost of vector control and cares for diseases attributed to mosquitoes have been evaluated. The survey shows that insecticide impregnated bednets represent an accessible and suitable control method subject to regular supply with reasonable prices and implementation of demonstration stations for the impregnation.
Two drug strategies for the control of malaria in children aged 3-59 months have been compared in a rural area of The Gambia--treatment of presumptive episodes of clinical malaria with chloroquine by village health workers, and treatment combined with fortnightly chemoprophylaxis with 'Maloprim' (pyrimethamine/dapsone) which was also given by village health workers. Treatment alone did not have any significant effect on mortality or morbidity from malaria. In contrast, treatment and chemoprophylaxis reduced overall mortality in children aged 1-4 years, mortality from probable malaria, and episodes of fever associated with malaria parasitaemia. A high level of compliance with chemoprophylaxis was obtained and no harmful consequences of chemoprophylaxis were observed.
Mortality and morbidity from malaria were measured among 3000 children under the age of 7 years in a rural area of The Gambia, West Africa. Using a post-mortem questionnaire technique, malaria was identified as the probable cause of 4% of infant deaths and of 25% of deaths in children aged 1 to 4 years. The malaria mortality rate was 6.3 per 1000 per year in infants and 10.7 per 1000 per year in children aged 1 to 4 years. Morbidity surveys suggested that children under the age of 7 years experienced about one clinical episode of malaria per year. Calculation of attributable fractions showed that malaria may be responsible for about 40% of episodes of fever in children. Although the overall level of parasitaemia showed little seasonal variation, the clinical impact of malaria was highly seasonal; all malaria deaths and a high proportion of febrile episodes were recorded during a limited period at the end of the rainy season.
The relationship between disease control, population growth and economic development is examined through a comparison of changes subsequent to malaria eradication campaigns in Sri Lanka and Sardinia. Both islands were similar in terms of malaria morbidity and mortality rates as well as a history of massive malaria eradication campaigns using DDT immediately after the Second World War. The critical comparative distinction is that Sardinia had a much lower population density than Sri Lanka. In both cases, the anticipated effects of malaria control were increased agriculture production in endemic zones coupled with a relief of population pressure in non-malaria areas. This has not happened. Patterns of demographic change, marked by sharp declines in general mortality and accelerated population rates, are similar in both cases. Malaria control has resulted in economic development in neither case, however, and this is explained using ecological and political-economic analyses.
The global program of malaria eradication coordinated and supported by the World Health Organization (WHO) since 1957 has been successful in most of the countries in the temperate climate zones of the globe. However, by the end of the 1960s it became evident that technical problems, such as resistance of mosquito vectors to insecticides and resistance of malaria parasites to drugs, presented serious obstacles to the pursuit of eradication programs in many tropical countries. Moreover, the administrative and financial difficulties of the developing countries were such that a revised strategy of antimalaria campaigns became necessary. In 1969 the World Health Organization recommended that although eradication of malaria should remain an ultimate goal, in countries where eradication does not appear to be feasible, malaria control operations may form a transitional stage. All effective methods of attack on the parasite and on the Anopheles vector should be employed according to epidemiological conditions of the area involved and in relation to their technical and logistic feasibility. Nevertheless, during the past decade the malaria situation has deteriorated in several countries, especially in southern and southeast Asia and some parts of Latin America. There has been no improvement in the highly endemic countries of tropical Africa. Since 1978 the concept of primary health care has been widely adopted, and antimalaria activities have become essential components of national health systems in many developing tropical countries. Malaria control within the orbit of primary health care aims first at the reduction of morbidity and mortality from malaria, although the decrease of the prevalence of this infection should also be an objective, whenever possible. This selective approach, based largely on chemotherapy, has been successful in a few countries, but in other areas the degree of integration of antimalaria activities with the primary health care system is less effective. Patterns of such integration depend on different epidemiological, socioeconomic, cultural, and other factors. Malaria control within the framework of primary health care demands full commitment by the government concerned, constant support of the community, and a close cooperation with all other sectors of the health system. Training of national professional and auxiliary staff and health education of the community are equally important.(ABSTRACT TRUNCATED AT 400 WORDS)
The low-birth-weight infant remains at much higher risk of mortality than the infant with normal weight at birth. In the neonatal period, when most infant deaths occur, the proportion of low-birth-weight infants, especially those with very low weight, is the major determinant of the magnitude of the mortality rates. Furthermore, differences in low-birth-weight rates account for the higher neonatal mortality rates observed in some groups, particularly those characterized by socioeconomic disadvantages. Much of the recent decline in neonatal mortality can be attributed to increased survival among low-birth-weight infants, apparently as a result of hospital-based services. The application of these services is currently considered cost-effective, although whether this will continue to be true in the future is unclear because of the increased survival of very tiny infants. Although low-birth-weight infants remain at increased risk of both postneonatal mortality and morbidity in infancy and early childhood, the risk is substantially smaller than that of neonatal death. In addition, these adverse later outcomes have not offset the gains achieved in the neonatal period. Nonetheless, the increased survival of high-risk infants raises concern about their future requirements for special medical and educational services and about the stress on their families. Despite increased access to antenatal services, only moderate declines in the proportion of low-birth-weight infants has been observed, and almost no change has occurred in the proportion of those with very low weight at birth. In addition, in many areas of the country the birth-weight-specific neonatal mortality rates are similar for groups at high and low risk of neonatal death. In view of these findings, continuation of the current decline in neonatal mortality and reduction of the mortality differentials between high- and low-risk groups require the identification and more effective implementation of strategies for the prevention of low-weight births.
This paper selectively reviews the main findings of studies on the possible effects of iron deficiency on cognitive function among infants and preschool children published after 1976, and presents data from a study recently conducted in rural Guatemala. In comparison to infants without signs of sideropenia, infants with iron deficiency with and without anemia tend to score lower in the Bayley Scale of Mental Development; conversely, there is no evidence for an association between iron deficiency and delayed motor development. Iron repletion therapy implemented over a period of 7 to 10 days is likely to result in an improvement in mental development scale scores among infants with iron deficiency with or without anemia. In comparison with preschool children without sideropenia, preschool children with iron deficiency with or without anemia are less likely to pay attention to relevant cues in problem solving situations.