Health and Economic Burden of Malaria and our Community
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Transcript Health and Economic Burden of Malaria and our Community
Health and Economic Burden
of Malaria and our Community
Environment
` A Case for Environmental Management Control of Malaria in
Anambra State ’
Henry Debem (Ph.D. Student)
Walden University, USA
PUBH 8165
Instructor : Dr. Lezah Brown-Ellington
Spring Term, 2013
Presentation Outline
Learning Objectives
What is Malaria?
Global Epidemiological Background of Malaria
Nigerian Context of Malaria Burden
Health and Economic
Brief Background of Anambra state
Current Malaria Control Measures in Anambra State
Common Points of Interference for Malaria Control
Key Stakeholders of Malaria Control in Anambra State
Environmental Risk Practices in Anambra State
Environmental Management Control (EMC) Measures
Efficacy and Cost Effectiveness of EMC
Other Advantages of EMC
Recommendations for Malaria Eradication in Anambra State.
Revision of the Learning Objectives
Learning Objectives
At the end of this presentation, participants will
be able to:
Learn mosquito and malaria cycle
Understand the health and economic burden of
malaria in the World and Nigeria
Learn the current control measures in Anambra
State and their Merits and Demerits
Understand the superiority of Environmental
Management Control over others
Make better informed and strategic decisions in the
fight against malaria in Anambra Communities and
beyond.
What is Malaria?
Vector-borne disease caused by
transmission of Plasmodium species by
Anopheles mosquitoes.
Plasmodium specie is the malaria
parasite that causes malaria in humans
Transmission occurs through mosquito
bites on humans during blood meals
Mosquitoes primarily breed in water
Plasmodium sp. and Mosquito Life Cycle
Images Retrieved from: 1. www.scienceblogs.com
2. Skeeters. www.bcps.org
Global Epidemiological Background of Malaria
Global and African Context:
Malaria, a serious global concern particularly in Africa
About half the world’s population (3.3 billion people) are
affected by Malaria
216 million cases occurred in 2010; 81% in African region
Malaria caused over 600,000 deaths in 2010; 91% in
African region
Third leading cause of death for children under 5 years
Almost 1 out of 5 deaths of children under 5 in Africa is
caused by Malaria
1. WHO (2013). Global health observatory. Retrieved from: http://www.who.int/gho/malaria/en/index.html
Nigeria Context of Malaria Burden
Health Burden:
Nigeria bears about 25% of the
Malaria burden in Africa
About 97% of the Nigeria’s
population is at risk of Malaria
Estimated 110 million malaria
cases and 300,000 death annually
Estimated 11% of maternal deaths
is caused by malaria
1. Chima, R., Goodman, C., & Mills, A. (2003). The economic impact of malaria in Africa: a critical review of the evidence. Health Policy, 63(1), 17-36.
2. National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.
3. WHO (2013). Global health observatory. Retrieved from: http://www.who.int/gho/malaria/en/index.html
Nigeria Context of Malaria Burden…2
Economic burden:
Costs can be divided into direct and indirect cost
Direct costs – households and government expenditures on treatment and prevention
Indirect costs – losses of labor productive time due to mortality and morbidity
Nigeria Government losses close to $1 billion ($868,421,052) annually (Jimoh, et al,
2007)
In general context (Other studies outside Nigeria):
Monthly expenditure on malaria treatment is between $0.41 and $3.88 per person
Treatment equivalent between $1.88 and $26 per household (Chima, et al, 2003)
Very poor households spend 28% of their income on Malaria
In Africa, government spend estimated $1.83 and $8.01 per person (Shepard, et al,
1991)
1.
2.
3.
Chima, R., Goodman, C., & Mills, A. (2003). The economic impact of malaria in Africa: a critical review of the evidence. Health Policy, 63(1), 17-36.
Jimoh, A., O. Sofola, A. Petu, and T. Okorosobo. 2007. “Quantifying the Economic Burden of Malaria in Nigeria Using the Willingness to Pay Approach.” Cost Effectiveness
and Resource Allocation 2007, 5:6. doi:10.1186/1478-7547-5-6.
Shepard, D., Ettling, M., Brinkmann, U., & Sauerborn, R. (1991). The economic cost of malaria in Africa. Tropical Medicine And Parasitology: Official Organ Of Deutsche
Tropenmedizinische Gesellschaft And Of Deutsche Gesellschaft Für Technische Zusammenarbeit (GTZ), 42(3), 199-203.
Brief Background of Anambra State
Created in 1991 and Located in the South
Eastern Nigeria
Eight most populated state (4,055,048)
and second most densely populated
(840/km2) in Nigeria.
Total area of 4,844 km2
Dominated by Igbos by tribe (98%)
Capital City as Awka, while Onitsha and
Nnewi are the biggest most commercial
cities
1. National Population Commission [NPC] (2008). Demographic and Health Survey [DHS] 2008.
Current Malaria Control Strategies in Anambra
Most Malaria program in Nigeria, including the 1998
WHO RBM program adopted these Strategies:
Diagnosis and treatment (D&T) with effective medicines
Distribution and use of insecticide-treated nets (ITNs) to
achieve coverage of populations at risk, with particular
focus on Children under 5 and Pregnant women
Indoor residual spraying (IRS) to curtail transmission
Intermittent preventive treatment (IPT)
1. National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.
Common Points of Interference for Malaria Controls
Concerns
No emphasis on the vectors
life cycle (Weak intervention)
Expensive particularly in
poor regions (Cost of regular
purchases and maintenance)
compliance requirements.
E.g. only 35% of the population in the
South Eastern Nigeria use at least one
bed net (NMCP,
2012).
1. Image retrieved from: www.crick.ac.uk
2. National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.
IPT, D&T
High behavioral adherence /
IPT, D&T
Stakeholders of Malaria in Anambra State
Government:
Federal and State of Ministries of Health
National and State Malaria Control Programs
Local Health Departments
Primary Health Care Departments
Non Governmental Organizations (NGOs)
Community based Non-Governmental Organizations
Community groups and Coalitions
Major Donor Agencies
WHO
USAID
DFID
World Bank
Global Fund
1. National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.
Environmental Management Control (EMC)
Strategies
Vegetation Clearance
Fumigation of bushes
Draining swamps
Surface application of oil to open
water bodies
Modification of River boundaries
Disposal of all potential open
water storage facilities and
objects away from residential
area.
1. Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine &
International Health: TM & IH, 6(9), 677-687.
Environmental Risk Practices in Anambra State
Indiscriminate dumps of refuses
and wastes close to residences
Dumps in swamps and drainages
causing stagnant waters
Abandonment of vegetation's
and bushes within residential
areas.
Farming within residential areas
Efficacy and Cost Effectiveness of EMC
Studies have shown that EMC in combination with
quinine and ITN is capable of:
Reducing malaria related incidence, morbidity, and
mortality rates by 70 – 95% within 3 - 5 years
Averting estimated 4173 deaths and 161,205 malaria
attacks in one local community in 20 years
Saving estimated $858 per death and $22.20 per attack .
Averting disability adjusted life year (DALY) to the cost
of $524 – 591 per DALY
1. Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine &
International Health: TM & IH, 6(9), 677-687.
Other Advantages of EMC
Strong benefits of the EMC strategy is the potential to:
Leverage the available community resources; hence, saving
great cost
Create more effective community sustainability and
ownership.
Encourage sound community participation and communal
efforts.
Provide less stringent behavioral compliance
No significant side effect
Address other of other environmental issues unrelated to
malaria.
Recommendations for Malaria Eradication in our
Communities
First, malaria eradication, rather than malaria control should be
emphasized in the state policy and strategic plan for communities.
Channel more proportion of Malaria control donor and
government funds to community EMC
Empower and involve the State environmental Protection Agency
(EPA) as active stakeholders in the fight against Malaria
Strengthen the community participation in the community EMC
Leverage the community resources to support this strategy
Empower the community leaderships to support this course in
every community.
1. Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine &
International Health: TM & IH, 6(9), 677-687.
Reference
Chima, R., Goodman, C., & Mills, A. (2003). The economic impact of malaria in Africa: a critical
review of the evidence. Health Policy, 63(1), 17-36.
Jimoh, A., O. Sofola, A. Petu, and T. Okorosobo. 2007. “Quantifying the Economic Burden of
Malaria in Nigeria Using the Willingness to Pay Approach.” Cost Effectiveness and Resource
Allocation 2007, 5:6. doi:10.1186/1478-7547-5-6.
National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.
National Population Commission [NPC] (2008). Demographic and Health Survey [DHS] 2008.
Shepard, D., Ettling, M., Brinkmann, U., & Sauerborn, R. (1991). The economic cost of malaria in
Africa. Tropical Medicine And Parasitology: Official Organ Of Deutsche Tropenmedizinische
Gesellschaft And Of Deutsche Gesellschaft Für Technische Zusammenarbeit (GTZ), 42(3), 199203.
Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental
management for malaria control. Tropical Medicine & International Health: TM & IH, 6(9), 677-
687.
WHO (2013). Global health observatory. Retrieved from: http://www.who.int/gho/malaria/en/index.html
Revision of Learning Objectives
Have we achieved the objectives of this presentation,
otherwise ask questions for further clarifications?
Do you understand the mosquito and malaria cycle?
Do you understand the health and economic? burden of
malaria in the World and Nigeria?
Do you know the available malaria control measures in
Anambra State and their Merits and Demerits?
Do you know the advantages of EMC over others?
Can you now make better informed and strategic decisions
on the fight against malaria in your communities?
1. Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine &
International Health: TM & IH, 6(9), 677-687.