“It has long been recognized that a malarious community is an impoverished community.”– T. H. Weller, a Nobel laureate in medicine.
Malaria and poverty are intimately connected. It is commonest in the poorest countries in the poorest continent, Africa. The only parts of Africa relatively free of malaria are the northern and southern extremes, which have the richest countries on the continent. Across the globe, some of the poorest countries in other continents also have a serious malaria problem, including India, the country with the greatest number of poor people in the world, and Haiti, the country that has the worst malaria in the Western Hemisphere, and it is the poorest country in the hemisphere. Where the burden of malaria is highest, economic prosperity is lowest.
Malaria has been noted since its discovery in – Ancient China about 5,000 years ago – to be of great economic value, albeit undesirable. Costing individuals, families and government productivity and lives, a lot of research has been done to study the economic burdens of malaria and its relationship with poverty. Concerning the latter, it seems to be a case of the chicken and the egg – which came first?
Many of the countries with the greatest burden of malaria today are poor and underdeveloped. Malaria is on its own a major cause of poverty as it can trap families and communities in a downward spiral of continuous poverty. When a member of the family has malaria, the families often lose their source of income in lost work hours and also lose money in procuring treatment. Consequently, there are lost hours at work, farms, schools, and markets which further worsens productivity and the poverty level.
Globally, Nigeria bore the heaviest burden of all countries with ongoing malaria transmission, with an estimated 9.4 million malaria cases in 2016 alone. Worryingly, cases are on the rise: WHO’s latest World malaria report showed an increase of more than 800 000 malaria cases nationwide between 2015 and 2016. Yet, it remains difficult to track and quantify the burden of the disease because the disease has become regarded as a ‘traditional disease’, which people assume to be part and parcel of their daily lives. This means that the individual sometimes does not give malaria the attention it deserves. For example, fever is automatically considered as malaria, leading to self-medication and resulting sometimes in late presentation for adequate assessment and treatment.
Cost of Malaria
Costs to individuals and their families include:
- Purchase of drugs for treating malaria: Malaria treatment can incur expenditures for consultation fees, drugs, and, in some cases, the cost of staying at the facility, for patient and family member. The poorest families across Africa are often unable to pay for treatment thus, disease progression is worse and longer. In 2013, 392 million artemisinin-based combination therapies (ACTs) were procured by the public and private sectors in endemic countries – up from 278 million in 2011, and just 11 million in 2005. If a family lives in a high transmission setting, it is possible that you could have frequent bouts of malaria which would result in a huge economic loss. These direct costs (for example, illness, treatment, premature death) have been estimated to be at least US$ 12 billion per year. The cost of lost economic growth is many times more than that.
- Expenses for travel to, and treatment at, dispensaries and clinics: In a continent with weak health care systems and facilities that may be far away, transportation costs and expenses for drugs may be particularly difficult.
- Lost days of work: When people are too sick to work, or their work capacity is reduced by illness, there are economic consequences. It is particularly evident in agrarian societies where families produce less when ill. The effect is worse if coincides with the harvest period. Furthermore, lost work days affects all the different sectors of the economy.
- Absence from school: Malaria may impair as much as 60% of the schoolchildren’s learning ability due to missed school days or a consequence of the sequelae of severe malaria, cerebral malaria. Across a population, this means higher failure rates, higher dropout rates, and poorer achievement. The total decrement in human capital development due to malaria is, however, unknown.
- Costs of managing resultant debility from malaria: Severe malaria illness, usually due to Plasmodium Falciparum is responsible for the most recorded deaths due to malaria. For those who survive, they may have lasting effects on their physical and mental —hence, economic— potential. The physical and cognitive effects are recognized, though poorly quantified.
- Expenses for preventive measures: Households purchase prevention items such as mosquito coils, sprays and repellents, and bed nets (with or without insecticide treatment) and these extra purchases further impoverish the family leading to less spending power and the loss of uptake of other important aspects of development.
- Deaths: Deaths from malaria also have clear economic consequences. The death of an adult has obvious economic consequences, leaving families without needed resources. The death of a child involves a different set of economic losses. Illness and death from malaria diminish the stock of “human capital” in many ways. Expenses for burial is also incurred.
- Increased Fertility: The deaths of one million children each year in sub-Saharan Africa up until the recent decline in mortality affected demographic patterns, directly and indirectly. The direct effects are obvious. Indirectly, they lead to high fertility and large family sizes. As a way to ensure surviving heirs or caretakers for when they are old, more children were born to balance the mortality rates in the countries most affected by malaria.
Many children per family mean fewer resources—including education, and health care — for each one. Girls often are given lowest priority for education, which adds fuel to the high fertility cycle. Employment choices are limited for women with many children; poorer health resulting from multiple pregnancies also detracts from women’s capacity to work. Over the long term, these conditions lead to high costs at the national and family level.
- Maintenance, supply and staffing of health facilities: Malaria is the number one reason for consultation in many countries across Africa. Its direct effect is the swelling of hospitals, clinics and health posts by patients who are on admission or are attending on an outpatient basis. This indirectly leads to greater pressure on facilities and available staff
- Purchase of drugs and supplies: To combat the mortality rates due to malaria, many governments in partnerships with NGOs provide free drugs, preventive materials, and rapid testing kits to areas most affected by malaria.
- Increased health care spending: The cost of malaria treatment in sub-Saharan Africa alone is said to have crossed the US $10 Billion mark in 2015 which causes a strain on national economies, reduces available funds for other aspects of the economy and leaves the poor, poorer and sicker.
Written by: Zubair Abdulahi
This appeared first in Hello Care…