Cost effectiveness of anti-malaria interventions
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Dear Professor Okeke and colleagues,
You probably know a whole lot more about malaria than I do...
certainly from the medical standpoint... and almost certainly in
terms of explaining why malaria has remained an unaddressed
health problem for all these years in Africa.
If there are around 450 million cases of malaria a year in Af-
rica... how much does this cost to treat? How much would it cost
to treat all these cases in the manner recommended by WHO, USAID
and others? How much loss of production is associated with this
morbidity? What cost/value do we attribute to some 3,000 deaths
every day from malaria, or more than 1 million every year?
What is the amount of financial resources that should be being
applied on the ground to address this problem? It is not an in-
significant amount. Would it not be better to reduce the inci-
dence of malaria, eliminating the source of the illness, rather
than having an almost exclusive focus on the better treatment of
malaria and the avoidance of mosquito bites.
What are the best interventions in terms of getting the most re-
sults from the least amount of resource use? What are the ex-
pected results and the expected costs from the following inter-
ventions?
*....... insecticide treated bednets (ITN)
PLUS
*....... interior residual spraying (IRS) of insecticides
PLUS
*....... cleaning up stagnant water that are breeding places for
mosquitos
PLUS
*....... wearing sensible clothes
PLUS
*....... using various forms of mosquito traps
PLUS
*....... outdoor insecticide spraying
PLUS
*....... ground fogging from a vehicle for whole neighborhood
PLUS
*....... aerial spraying for areas where mosquitos thrive (such
as marshes and swamps
PLUS
*....... larvicides in water bodies that cannot be drained
PLUS
*....... prophylactic medication
PLUS
*....... curative medication when needed.
What other interventions should be considered?
I believe the mix of interventions should depend on the commu-
nity, rather than on donor strategy. In some places one thing
will work best, and in another place it may be something else.
If malaria is an endemic problem what should we be measuring so
that we know what progress is being achieved... obviously we
should know the cost of doing various things, but what should be
expected from every US$ 1,000 deployed. What is the best way to
get maximum value for money?
There is a critical dialog about the efficacy of DDT. It has
been very helpful in getting control of malaria in many parts of
the world. It was banned because of concern about unintended
side effects that are less obvious now than originally antici-
pated. Other insecticides are available, but are more costly.
With so much death, and so little money, it looks like DDT
should be a component of the interventions. But if it is not,
then more money can still achieve the goal.
I would welcome feedback about the costs and impacts of various
interventions.
Sincerely,
Peter Burgess
Tr-Ac-Net in New York
Tel: +1-212-772-6918
mailto:peterbnyc@gmail.com
The Transparency and Accountability Network
With Kris Dev in Chennai India
and others in South Asia, Africa and Latin America
http://tr-ac-net.blogspot.com
http://www.tr-ac-net.org