Economic aspects of suppressing malaria in Africa.

Background: Suppressing malaria in Africa is costly, but is it a good way for international agencies to use their funds, or alternatively, for the African nations that are the direct beneficiaries? Unfortunately, the current ephemeral methods in the malaria strategy of the World Health Organization have required continuous and rising expenditures by international donors who were beginning to lose interest by 2010. To avoid becoming hostage to international economic limitations, African countries might want to consider suppressing malaria themselves, and might want to add permanent and lasting methods to the WHO strategy. The purpose of this study was to determine whether investments in suppressing malaria might produce significant benefits for African nations. Materials and Methods: Two epidemiologic analyses were used in parallel to evaluate data from Africa: a before-after comparison of countries treated under the US President's Malaria Initiative for Africa (PMI), and a simultaneous comparison of treated-untreated countries. Results: From 2007 to 2012, relative increases in population and gross domestic product (GDP) were greater in 14 countries treated as part of PMI than in 9 similar, but untreated countries. In the treated countries the relative increase in the GDP of 0.61 before malaria suppression rose to 0.64 afterwards; whereas in the untreated countries it fell from 0.67 to 0.56. The increase in GDP in the 14 treated countries that was attributable to malaria suppression over the 5-year interval was about $4.77 billion. During that period, the mean cost of suppressing malaria had been about $1.43 billion, indicating a return on the investment of 3.4 to 1. However, the costs began rising steeply in 2012. Conclusions: Malaria suppression might be worthwhile for African countries to undertake themselves, as long as the biocides and drugs in current use remain effective.

Suppression of malaria transmission and increases in economic productivity in African countries from 2007 to 2011.

Background: To test the assumption that reductions in malaria in Africa will increase economic productivity, a correlation-regression analysis was conducted to evaluate the impact of expenditures by the US President's Malaria Initiative for Africa (PMI), and increases in the economic productivity of countries included in the PMI. Materials and Methods: For the 12 most representative countries the per capita expenditures for malaria suppression in the 2011 budget of the PMI were compared with observed increases in per capita economic productivity. The measure of economic productivity used was the per capita Gross Domestic Product (GDP) for the period 2007 to 2011. Results: With a mean annual expenditure for suppressing malaria slightly above 1 US dollar per capita (range 0.44-3.40), there was a positive but weak correlation of higher expenditures with increased economic productivity. The correlation coefficient r was 0.5. The increase in per capita GDP in these countries over the 4-year period varied between 60 and 200 USD. The slope of the regression line and thus the ratio of benefits to cost from this programme varied slightly between ecologic zones, but the mean was 6.75 to 1. This meant that there was an increase in per capita GDP of $6.75 for every $1 invested per capita in suppressing malaria. Conclusions: The high benefits to cost ratio from the PMI makes suppression of malaria by methods used by the initiative potentially an attractive investment, at least for the near future while the biocides and drugs deployed are still effective.

Difficulties in organizing first indoor spray programme against malaria in Angola under the President's Malaria Initiative.

PROBLEM: Successful attempts to control malaria require understanding of its complex transmission patterns. Unfortunately malaria transmission in Africa is often assessed using routine administrative reports from local health units, which are plagued by sporadic reporting failures. In addition, the lack of microscopic analyses of blood slides in these units introduces the effects of many confounding diseases. APPROACH: The danger of using administrative reports was illustrated in Angola, the first country in which malaria control was attempted under the President's Malaria Initiative, a development programme of the Government of the United States of America. LOCAL SETTING: Each local health unit submitted monthly reports indicating the number of suspected malaria cases to their municipality. The identification of the disease was based on clinical diagnoses, without microscopic examination of blood slides. The municipal and provincial reports were then passed on to the national headquarters, with sporadic reporting lapses at all levels. RELEVANT CHANGES: After the control effort was completed, the defective municipal reports were corrected by summarizing only the data from those health units which had submitted reports for every month during the evaluation period. LESSONS LEARNED: The corrected data, supplemented by additional observations on rainfall and mosquito habitats, indicated that there had probably been no malaria transmission before starting the control operations. Thus the expensive malaria control effort had been wasted. It is unfortunate that WHO is also trying to plan and evaluate its malaria control efforts based on these same kinds of inadequate administrative reports.