Malaria, a parasitic disease transmitted by mosquitoes, is unique among diseases as its roots are embedded deep within human communities. At present, many of the world’s poor countries are facing high rates of malaria endemism. The World Health Organization (WHO) reports that malaria causes over 300 million episodes of “acute illness” and more than one million deaths annually. 430,000 malarial deaths occurred in 2015 with Africa alone accounting for 90% of these deaths and 85% victims being below age 5. The tropics located around the equator and the sub-tropical region are most susceptible to malarial diseases, as they offer a conducive climate for the growth of malarial vectors. This includes much of Sub-Saharan Africa, Asia and Latin America, (interestingly, the poorest regions in the world), as is evident in Figure 1. The incidence of malaria in the temperate regions is less due to seasonality of malaria transmission, low night-time outdoor temperatures - thus less efficient malaria vectors. This article contextualises the cost of the tiny insects by analysing the extent to which the absence of a malaria-free climate stymies progress in these countries.
Malaria and Economic growth
Africa, on average spends 12 billion dollars every year in the form of health care costs, absenteeism, and days lost in education and decreased productivity as a consequence of high malarial intensity. Malarial protection is imperfect and cumbersome and this leads to well-to-do foreign investors and tourists shying away from such countries.A study done by Sachs and Gallop shows that for the period 1965-1990 taking into account the initial poverty, economic policy, tropical location, and life expectancy, among other factors, countries with intensive malaria grew 1.3% less per person per year, and a 10% reduction in malaria was associated with 0.3% higher growth. Similar study done on the country Uganda showed that when malaria morbidity increased by one unit, while holding all other explanatory variables constant, per capita GDP decreased by US$0.00767 per year. This amounted to a total loss of US$ 49,825,003 for the year 2003 (Orem et. al, 2012). Thus, malaria morbidity does have a significant negative influence on a countries economic growth.
Interventions: Are they effective?
Insecticide treated bed nets(ITN) have been found to be the most cost effective, affordable and efficient prevention method. Unlike the traditional untreated bed nets, the ITNs are made up of chemical combinations that can weaken or kill mosquitoes when they come in contact. The most vulnerable targets of malaria are the children under the age of 5 and it has been shown that correct usage of ITNs could save as many as 336000 malaria related deaths in children every year. However, even then the usage of bed nets in places like Nigeria remain significantly low despite the government distributing it for free. The Health belief model (HBM) could give an explanation for this behaviour.The HBM was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels working in the U.S. Public Health Services. It is a widely used model to study the factors affecting a persons’ decision to take preventive care. The following are the constructs of the HBM defined using malaria: (1) Perceived Susceptibility to the health problem - whether children are at a risk of malaria (2) Perceived Seriousness of the health condition - severity of malaria, social and health consequences (3) Cues to action - witness the death or illness of a relative due to malaria(4) Belief in effectivenessof new behaviour - whether treated bed nets are effective (5) Barriers to taking action – impediments to using bed nets (6) Self- efficacy – confidence in the ability to pursue a new behaviour.
Various surveys conducted in Nigeria have shown that caregivers are aware that their children are vulnerable to malaria. In fact, the indigenous language has even defined the less dangerous mosquito types as “abo – iba” translated as “female malaria” and the more dangerous mosquito type as “ako – iba” translated as “male malaria”. They can even make out the common symptoms of infection. The perceived seriousness is also high as they know that deformities and long term illnesses can develop if malaria strikes someone at a young age. They see their children suffering from anorexia and can understand that malaria is a life threatening disease. Death of a closed one due to malaria produces a strong emotion that urges people to take preventive action. These cues should be enough to stimulate people to use cost effective prevention strategies. But here comes the problem. Despite knowing that ITNs are effective people are not ready to use them. The problem comes in both, at the societal level and at the individual level. At the societal level this is a classic distribution problem. There is corruption and nepotism in the distribution of the free nets. The local rural centres that distribute these nets are far and few. It does not reach the intended beneficiaries. There is also a lack of impetus at the individual level as well. There is a common belief that these nets increase heat and also give rise to problems of sneezing and coughing. Users of these nets in the past did not show much significant difference due to its use. They believe that mosquitoes can bite at any time of the day and bed nets are of no help. Traditional practices such as burning the leaves of the local plants near the bed are widely accepted and followed. The poor, resell these ITNs in the markets to earn money.
BJ Fogg, a professor at Stanford, came up with a model for behaviour, where he pointed out that in order to induce behaviour (B) a person should have motivation (M), ability (A) and a trigger (T) to induce him into action (B = MAT). Since the practice of using ITNs is still non-routine and socially deviant, it does not provide sufficient motivation and trigger to induce a person into action. What is needed is strong local community support and a strong transparent administration. Free distribution must be combined with social marketing of bed nets. Nudge interventions such as reminder messages containing cues to action, personalised messages, social validation and visits by local bodies might be effective.
References
Abdullahi, A. A., Van Zyl-Schalekamp, C., &Seneka, A. (2013). Perceived threat of malaria and the use of insecticide treated bed nets in Nigeria. African Sociological Review/Revue Africaine de Sociologie, 17(1), 25-44.
Gallup, J. L., & Sachs, J. D. (2001). The economic burden of malaria. The American journal of tropical medicine and hygiene, 64(1_suppl), 85-96.
Orem, J. N., Kirigia, J. M., Azairwe, R., Kasirye, I., & Walker, O. (2012). Impact of malaria morbidity on gross domestic product in Uganda. International archives of medicine, 5(1), 12.