Essays on the economic and social-behavioral effectiveness of
large scale malaria control programs in three sub-saharan Africa
Essays on the economic and social-behavioral effectiveness of large scale malaria control programs in three sub-saharan Africa countries
Dissertation (198 pages)
Committee Chair / Thesis Adviser: McFarland, Deborah A
Committee Members: Howard, David H ; Stephenson, Robert ; Kachur, Stephen (CDC);
Research Fields: Health Sciences, Public Health; Economics, General
Keywords: Malaria Control; Socio-Economic Inequalities; Program Cost-effectiveness; Maternal Education; Childhood Infections; Free bed-net distributions
Program: Laney Graduate School, Health Services and Research Health Policy
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 Supplementary data are obtained from study countries' national malaria control programs, as well as published and unpublished study reports.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
MIS Introduction and Overview.pdf 10 pages (150.1 KB) [supplemental file for Dissertation]
MIS Household Questionnaire.pdf 4 pages (23.3 KB) [supplemental file for Dissertation]
MIS Woman Questionnaire.pdf 12 pages (48.1 KB) [supplemental file for Dissertation]