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Efficacy and cost-effectiveness of environmental management for malaria control

Author

Listed:
  • Jurg Utzinger

    (Princeton University)

  • Yesim Tozan

    (Princeton University)

  • Burton H. Singer

    (Princeton University)

Abstract

Roll Back Malaria aims at halving the current burden of the disease by the year 2010. The focus is on sub-Saharan Africa, and it is proposed to implement efficacious and cost effective control strategies. However, the evidence-base of such information is scarce, and a notable missing element is discussion of the potential of environmental management. We reviewed the literature and identified multiple malaria control programmes that incorporated environmental management as the central feature. Prominent among them are programmes launched in 1929 and implemented for 2 decades at copper mining communities in Zambia. The full package of control measures consisted of vegetation clearance, modification of river boundaries, draining swamps, oil application to open water bodies and house screening. Part of the population also benefited from quinine administration and was sleeping under mosquito nets. Monthly malaria incidence rates and vector densities were used for surveillance and adaptive tuning of the environmental management strategies to achieve a high level of performance. Within 3-5 years, malaria related mortality, morbidity and incidence rates were reduced by 70-95%. Over the entire 20 years of implementation, the programme had averted an estimated 4,173 deaths and 161,205 malaria attacks. The estimated costs per death and malaria attack averted were US$ 858 and US$ 22.20, respectively. Over the initial 3-5 year start-up period, analogous to the short-duration of cost-effectiveness analyses of current studies, we estimated that the costs per disability adjusted life year (DALY) averted were US$ 524-591. However, the strategy has a track record of becoming cost-effective in the longer term, as maintenance costs were much lower; US$ 22-92 per DALY averted. In view of fewer adverse ecological effects, increased sustainability and better uses of local resources and knowledge, environmental management integrated with pharmacological, insecticidal and bednet interventions could substantially increase the chances of rolling back malaria.

Suggested Citation

  • Jurg Utzinger & Yesim Tozan & Burton H. Singer, 2001. "Efficacy and cost-effectiveness of environmental management for malaria control," Working Papers 266, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
  • Handle: RePEc:pri:cheawb:16
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    Citations

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    Cited by:

    1. Matteo Pedercini & Santiago Movilla Blanco & Birgit Kopainsky, 2011. "Application of the Malaria Management Model to the Analysis of Costs and Benefits of DDT versus Non-DDT Malaria Control," PLOS ONE, Public Library of Science, vol. 6(11), pages 1-12, November.
    2. Henry Musoke Semakula & Guobao Song & Simon Peter Achuu & Miaogen Shen & Jingwen Chen & Paul Isolo Mukwaya & Martin Oulu & Patrick Mwanzia Mwendwa & Jannette Abalo & Shushen Zhang, 2017. "Prediction of future malaria hotspots under climate change in sub-Saharan Africa," Climatic Change, Springer, vol. 143(3), pages 415-428, August.
    3. Resign Gunda & Moses John Chimbari & Samson Mukaratirwa, 2016. "Assessment of Burden of Malaria in Gwanda District, Zimbabwe, Using the Disability Adjusted Life Years," IJERPH, MDPI, vol. 13(2), pages 1-12, February.
    4. Solomon Kibret & G Glenn Wilson & Darren Ryder & Habte Tekie & Beyene Petros, 2018. "Can water-level management reduce malaria mosquito abundance around large dams in sub-Saharan Africa?," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-12, April.
    5. Janeth Marwa & Mesia Lufingo & Chicgoua Noubactep & Revocatus Machunda, 2018. "Defeating Fluorosis in the East African Rift Valley: Transforming the Kilimanjaro into a Rainwater Harvesting Park," Sustainability, MDPI, vol. 10(11), pages 1-12, November.
    6. Julia Reis & Teresa B. Culver & Paul J. Block & Matthew P. McCartney, 2016. "Evaluating the impact and uncertainty of reservoir operation for malaria control as the climate changes in Ethiopia," Climatic Change, Springer, vol. 136(3), pages 601-614, June.
    7. Alan Martina, 2009. "On the Constrained Contribution of Advances in Medical Knowledge to the Economic Growth of Developing Countries," ANU Working Papers in Economics and Econometrics 2009-504, Australian National University, College of Business and Economics, School of Economics.
    8. McCartney, Matthew, 2009. "Improved planning of large dam operation: using decision support systems to optimize livelihood benefits, safeguard health and protect the environment. CPWF project report, project number 36," IWMI Research Reports H042678, International Water Management Institute.
    9. Alan Martina, 2007. "A Class of Poverty Traps: A Theory and Empirical Tests," ANU Working Papers in Economics and Econometrics 2007-482, Australian National University, College of Business and Economics, School of Economics.

    More about this item

    JEL classification:

    • I19 - Health, Education, and Welfare - - Health - - - Other

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