Saving Lives, Buying Time Economics of Malaria Drugs in an Age of Resistance (2004) / Chapter Skim
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7 The Human and Economic Burden of Malaria
7 The Human and Economic Burden of Malaria
Pages 168-196
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From page 168... ...
In the public sector, large fractions of health sector budgets are spent on malaria control and treatment. And at the macroeconomic level, a heavy national burden of malaria dampens economic development, sometimes subtly, but pervasively.
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From page 169... ...
. WHO's most recent estimate of malaria deaths is similar -- a worldwide total of 1,124,000 deaths due directly to malaria in 2001, of which about 970,000 would have been in Africa (WHO, 2002)
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From page 170... ...
Class 4: populations exposed to stable, endemic malaria transmission. In southern Af rica (Namibia, Swaziland, South Africa, Botswana, Zimbabwe)
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From page 171... ...
of Clinical Attacks (thousands) of Malaria during 2000 0-4 years 5-14 years 15+ years Total Southern Africa 60 109 255 424 malaria risk [20 [36 [84 [140 (Class 4)
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From page 172... ...
The BOMA project began in 1998 with the aim of assembling in a single database all available evidence on morbidity, disability, and mortality associated with falciparum malaria in Africa, starting as far back as possible. The data come not only from the usual electronic databases, but from hand searches of early, unindexed papers in English and French tropical medicine journals, and a mass of unpublished material from local and regional conference proceedings, libraries, and Ministries of Health records (Snow et al., 2001)
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From page 173... ...
The data used to describe these trends, are by their nature, limited and not entirely comparable. The pre-1960 data are mainly from colonial Anglophone Africa, where malaria deaths were tracked through civil notification systems operating in defined populations.
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From page 174... ...
How can the observed trends in malaria mortality among African children be explained? The positive effects on total mortality are a plausible result of expanded basic health services, including vaccinations, the widespread adoption of oral rehydration therapy, expanded access to antibiotics, and at least in places, improved sanitation and general living condi
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From page 175... ...
The remainder of this section is based on Trape's report. Population-Based Studies Three studies tracked childhood malaria mortality in populations over the period in which chloroquine resistance emerged, from the mid-1980s to the mid-1990s.
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1984-1991 1992-1995 1992 <10 malaria death rate (per 1,000) 4.0 8.2 Resistance from RII/RIII: RII/RIII: standardized surveys 10% (1993)
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From page 177... ...
. Other Types of Evidence from Hospital-Based Studies Various other studies, including one of trends in severe anemia in Kenya, and another of changes in hospital case fatality rates for malaria after a switch from chloroquine to SP, provide corroborating evidence that chloroquine resistance has led to increases in severe malaria and malaria deaths (Trape, 2001)
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From page 178... ...
. Ideally, to understand the influence of malaria, one would start with a top-down approach, deriving dollar figures that represent the aggregate economic effects of malaria in a nation or region -- the macroeconomic approach -- and then working from the ground up, uncovering the detailed chains of causation leading to various streams of cost -- the microeconomic approach.
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From page 179... ...
observed: The development of health statistics during the 19th century, the economic motivations of the European colonial enterprise, the obvious recognition of malaria as a serious obstacle and the need of important investments for its control, lead to early efforts to define the malaria problem as a burden on society, measurable first in economic terms, such as lost productivity, and later including more general so cial values, such as learning ability and impact on education. Perhaps even more obvious than the continual, insidious costs of endemic malaria, the high human and financial costs associated with malaria epidemics have been recognized since antiquity.
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From page 180... ...
The microeconomic costs most often measured include the direct expense, to both government and individuals, of preventing and treating the disease, and the indirect costs of being sick with malaria. The Effects of Malaria at the Macroeconomic Level Malaria and poverty occupy common ground.
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From page 181... ...
The total decrement in human capital development due to malaria is, however, unknown. Trade and Foreign Direct Investment The failure of malarious countries to attract foreign investment has undoubtedly had a major influence on economic development.
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From page 182... ...
Between the two periods, malaria incidence declined by 68 percent aver aged over the country, and malaria mortality declined, on average, by 91 percent across the country, varying by province. Incidence in the earlier period ranged from roughly 1 percent to 16 percent among geographic regions.
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From page 183... ...
Looking only at the direct costs of preventing and treating malaria appears to grossly underestimate the overall effect of the disease, and the extent to which controlling it benefits people. Even if some of the benefit observed in this study resulted from other factors that were not measured, a large share is almost certain ly due to the generalized effects of malaria control.
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From page 184... ...
In the human capital approach, the immediate costs of treating or preventing an episode of illness consist of the "direct" costs -- money spent for malaria prevention and treatment, including, for example, the cost of bednets and mosquito repellents in the first instance, and of consulting a health provider, buying drugs, and paying for transportation, in the second. Indirect costs represent loss of income (or productive labor, even if the benefits are not monetized, e.g., lost agricultural production because of an inability to plant or harvest crops)
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From page 185... ...
Indirect Costs When people are too sick to work, or their work capacity is reduced by illness, there are economic consequences: wage earners are paid less; agriculturists may produce less (particularly if illness coincides with the harvest) ; sick children themselves cannot work (even some very young children work)
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From page 186... ...
, based on approximately 4.2 million people experiencing malaria per year, of whom 2.5 million were assumed to be workers. The costs included direct costs of treatment for everyone plus lost workdays (valued at an average daily wage rate)
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From page 187... ...
Some of the aspects not generally captured by the human capital method relate to coping strategies adopted by families, which affect their economic well-being in ways not usually measured through direct and indirect costs usually measured. Coping Strategies with Effects Not Captured by the Human Capital Method In addition to paying for malaria prevention and treatment with cashon-hand, and losing wages and other productive labor, families cope with malaria in ways that diminish their overall economic wellbeing.
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(1999) Ethiopia 50% or 100% of the average daily wage Ettling et al.
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18 days (total of 21 days 2 days (total of 12 days $623 for adults & lost, taking account of lost, taking account of teenagers; $312 for labor substitution) labor substitution)
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The anticipatory coping strategies are more subtle, but can have major economic consequences. In a labor market where illness is common, these may include limiting staff specialization or maintaining labor reserves to ensure a sufficient workforce, both of which reduce overall average productivity.
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From page 191... ...
, in order to compare those figures with how much people were willing to pay to prevent malaria. If accurate, the amount that people are willing to pay to prevent malaria would capture the value placed on the economic losses as well as the pain and suffering caused by malaria, within the financial means of real families.
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From page 192... ...
Indirect costs of illness are based on productive time lost by patients themselves, other family members caring for patients, and family members substituting for patients at their work. The average adult loss per episode was 21 days.
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From page 193... ...
193 Costs Low Prod 9 Annual US$) Total (1997 High Prod 31 d Cost US$)
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From page 194... ...
Adding up all of the effects from the best microeconomic studies using the human capital method, the totals do not begin to approach the magnitude of effect seen with top-down macroeconomic approaches. The human capital method, as practiced, underestimates costs in ways that are identifiable, as well as some that have yet to be defined.
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American Journal of Tropical Medicine and Hygiene 64(1-2 Suppl)
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From page 196... ...
2004. Does reducing malaria improve household living standards?
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