Essays on the economic and social-behavioral effectiveness of large scale malaria control programs in three sub-saharan Africa countries Open Access
Njau, Joseph (2013)
Abstract
Increased global health funding has accelerated the rollout of effective malaria control packages. Little is known about the effectiveness of some of these interventions in terms of reducing socioeconomic inequalities, effective pathways for long-term and sustainable community engagements to malaria control efforts and also the cost- effectiveness of some interventions such as the universal malaria diagnostic testing in children under-five years of age.
We use Malaria Indicator Survey (MIS) data collected from three sub-Saharan Africa countries to explore the effectiveness of large scale malaria control implementation programs being undertaken in the region. Supplementary data are obtained from study countries' national malaria control programs, as well as published and unpublished study reports. Regression and decision tree models are used in the data analysis. Additionally, marginal effects and Blinder-Oaxaca decomposition techniques are employed to put the results in better perspective.
Targeted free bed-net distributions increased household overall ownership of bed-nets but the poorest households remained disproportionately underserved. Children in wealthier households were up to 12 percentage points less likely to test positive for malaria and were more likely to own and use bed-nets. Poorest households were significantly more likely to have children testing malaria positive. Meanwhile, maternal education was associated with a 4.7 percentage point reduction in childhood malaria infections. Adoption of malaria Rapid Diagnostic Test (mRDT) strategy was cost-effective across the three study countries relative to presumptive treatment strategy. The mRDT strategy exhibited higher probability to save children's lives relative to presumptive malaria treatment strategy.
Targeted free distribution of bed-nets did not achieve equitable bed-net access and use. Inequities were caused by factors other than financial constraints alone. Maternal education and choice of malaria control strategy are critical for successful and sustainable malaria control. Malaria control policies like adoption of mRDT strategy were variably cost-effective. Malaria control efforts should focus on tapping the current global momentum with coalition of diverse financing partners for effective and sustainable malaria control. Partners should be flexible enough when disbursing malaria control resources for countries to tailor control policies that reflect their epidemiological, social and economic needs.
Table of Contents
Abstract Acknowledgement Table of Contents List of Tables List of Figures Chapter 1 General Introduction Global Malaria Burden Historical Context of Global Malaria Funding and Control Efforts Problem Statement Study Objectives Specific Objectives Structure of the Thesis Chapter 2 Literature Review Introduction Malaria interventions and health inequalities The role of Socio-behavioral factors in improving child health and malaria control programs Cost-effectiveness of Malaria Interventions: The case of universal malaria rapid diagnostic tests (mRDT) in young children Review Synthesis Existing Malaria Policy Context Chapter 3 Description of Study Sites, Data Source and Limitations Description of study sites and malaria control initiatives Angola Tanzania Uganda Data Sources Description of MIS data collection process Sample size and survey designs MIS Questionnaires and Malaria testing Analytical Framework Data Limitations Chapter 4 Exploring the impact of targeted distribution of free bed-nets in mediating the relationship between household socioeconomic disparities and a set of childhood malaria indicators Abstract Background Description of Study Sites and malaria control efforts Angola Tanzania Uganda Materials and Methods Outcome variables Empirical Analysis Interaction terms Results Discussion Policy Implications Conclusions Chapter 5 Exploring the linkages between maternal education and childhood malaria infections Abstract Background Delineating the pathways Data and Methods Independent Variables Other Control Variables Estimation Strategy Blinder - Oaxaca Decomposition Results Discussion Conclusions Chapter 6 A comparative study on cost-effectiveness analysis for adopting universal malaria rapid diagnostic tests (mRDT) for children under-five years of age: With Evidence from Malaria Indicator Survey Data in three sub-Sahara African Countries. Abstract Introduction Methods Study Area Description of study design and data Analytical Approach Effectiveness Indicator and cost-effectiveness measure Sensitivity Analysis Results Results from the sensitivity analyses Discussion Study limitations Conclusions Chapter 7 Discussions Policy Implications and Overall Conclusions Introduction General Discussions Policy Implications Overall Study Limitations Areas for further Research Conclusions REFERENCES Appendix 1: CEA Model Parameter Inputs and Data Sources Appendix 2: Baseline Malaria Country Profiles Appendix 3 Malaria Indicator Survey (MIS) Questionnaire Modules
About this Dissertation
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Primary PDF
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Essays on the economic and social-behavioral effectiveness of large scale malaria control programs in three sub-saharan Africa countries () | 2018-08-28 11:11:35 -0400 |
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Supplemental Files
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MIS Introduction and Overview.pdf () | 2018-08-28 11:16:16 -0400 |
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MIS Household Questionnaire.pdf () | 2018-08-28 11:16:54 -0400 |
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MIS Woman Questionnaire.pdf () | 2018-08-28 11:18:11 -0400 |
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