Health and agricultural productivity: Evidence from Zambia

The impact of health on labour market outcomes: A rapid systematic review

The relationship between an individual's health and their labour market outcomes has long been a subject of health economics research. This review aims to provide an up-to-date, global review of the substantive findings in the existing literature. We pay particular attention to causal effects, acknowledging the methodological complexities that have long challenged the research and emphasizing the importance of overcoming them to present robust, policy-relevant evidence. The recent literature shows a notable advancement in addressing these methodological issues compared to previous work. The evidence reviewed suggests that individuals with better health overwhelmingly exhibit higher earnings and often enhanced labour supply. These findings extend beyond geographical boundaries, as evidence from diverse regions underscores the global significance of this association. The review covers evidence from a wide range of health indicators and conditions - including e.g. self-reported health, chronic diseases, disability, nutritional health, infections, mental health, addictions and others. Within and across the different health domains, the health-related factors exert varying degrees of influence on labour market outcomes, highlighting the multifaceted nature of the health-labour relationship and its potentially profound implications for individuals, communities, and economies.

The effect on income of providing near vision correction to workers in Bangladesh: The THRIVE (Tradespeople and Hand-workers Rural Initiative for a Vision-enhanced Economy) randomized controlled trial

INTRODUCTION

Presbyopia, the leading cause of vision impairment globally, is common during working years. However, no trials have assessed presbyopia's impact on income.

METHODS

In April 2017, we conducted a census among 59 Bangladesh villages to identify persons aged 35 to 65 years with presbyopia (presenting distance vision > = 6/12 bilaterally and correctable inability to see 6/13 at 40 cm with both eyes), who never had owned glasses. Participants were randomized (1:1) to receive immediate free reading glasses (intervention) or glasses delivered 8 months later (control). Visual demand of different jobs was stratified into three levels. Outcomes were between-group differences in the 8 month change in: self-reported monthly income (primary) and Near Vision Related Quality of Life (NVRQOL, secondary).

RESULTS

Among 10,884 census participants, 3,655 (33.6%) met vision criteria and 863 (23.6%) comprised a sample enriched for near vision-intensive jobs, but 39 (4.52%) could not be reached. All participants allocated to intervention (n = 423, 51.3%) and control (n = 401, 48.7%) received the appropriate intervention, and follow-up was available for 93.4% and 96.8% respectively. Groups were similar at baseline in all characteristics: mean age was 47 years, 50% were male, 35% literate, and about half engaged in "most near vision-intensive" occupations. Glasses wear at 8-month follow-up was 88.3% and 7.81% in intervention and control respectively. At baseline, both the intervention and control groups had a self-reported median monthly income of US$35.3. At endline, the median income for the intervention group was US$47.1 compared with US$35.3 for control, a difference of 33.4%. Predictors of greater income increase in multivariate models included intervention group allocation (OR 1.45, 95% CI 1.12, 1.88, P = 0.005), male sex (OR 2.41, 95% CI 1.84, 3.16, P <0.001), and not engaging in income-producing work at baseline (OR 2.35, 95% CI 1.69, 3.26, P<0.001).

CONCLUSION

Provision of reading glasses increases income in near vision-intensive occupations, and may facilitate return to work for those currently unemployed.

The economic impacts of house screening against malaria transmission: Experimental evidence from eastern Zambia

Malaria imposes an economic burden for human populations in many African countries, and this burden may be reduced through house screening initiatives. We use a randomized controlled trial to measure the economic impacts of house screening against malaria infection. We use a sample of 800 households from 89 villages in rural and peri-urban Zambia to collect baseline data in August 2019 and endline data in August 2020. The main outcome variables are (self-reported) malaria prevalence rates, labor supply, and income, and consider individual and household-level outcomes. House screening reduces malaria prevalence, the number of sick days due to malaria, and the number of malaria episodes. Impacts on adults are more pronounced than on children. In terms of economic impacts, house screening increases labor supply and (household) income. We find particularly large effects on labor supply for women household members. A cost-benefit analysis, based on estimated benefits and measured costs, suggests that the private benefits of house screening exceed the costs. While not all houses are suitable for house screening, we conclude that screening is a promising and cost-effective approach to reduce malaria infections.

The Relationship between Chronic Non-Communicable Diseases of Fish Farm Household Members and Production Efficiency: The Case of Ghana

Prior studies explored the production and technical efficiency of fish farms and farmers from the perspectives of factors such as credit access and cooperative membership. We focused on the chronic non-communicable diseases (NCDs) of household members and their quantitative impacts on fish farm production efficiency, based on data of earthen pond fish farms from two regions (Bono East and Ashanti) in Ghana. A data envelopment analysis (DEA) and the IV Tobit technique were employed for the study's analysis. From the study's observations, we draw the following conclusions. We found that the NCDs of household members indeed reduce farm production efficiency, and the heterogeneous impact of the NCDs of female members on farm production efficiency was more prominent than that of male members. Insights from this study suggest that the national government should provide farmers with the necessary medical care through the provision of subsidized health insurance, which can facilitate access to healthcare services. Moreover, NGOs and governments should encourage health literacy, i.e., organizing programs aimed at educating farmers on NCDs and their impact on agriculture.

Spatio-Temporal Differences in Economic Security of the Prefecture-Level Cities in Qinghai-Tibet Plateau Region of China: Based on a Triple-Dimension Analytical Framework of Economic Geography

The assessment of regional economic security (RES) is mainly based on the theoretical ideas of political economy and marginalism, and the research areas are mainly concentrated in European and American countries/regions, especially Eastern Europe. Taking the Qinghai-Tibet Plateau in China as an example, this paper constructs a triple-dimensional analytical framework, resources, and environmental-economic foundation-driving forces, based on the institutional approach of economic geography, with the purpose of making up for the deficiency of the extant literature, which pays little attention to regional characteristics and the dynamic mechanism concerning RES, and to provide a tool to identify key factors affecting RES. This paper obtained the main conclusions as follows. (1) The index of the economic security in the Qinghai-Tibet Plateau is on the rise, and the difference at the level of RES among cities is significant but tends to decrease. (2) There is a significant spatial autocorrelation among cities in the Qinghai-Tibet Plateau in terms of RES. The high-value areas are concentrated along the southeast edge, and the low-value areas are concentrated in the central areas of the west. (3) Despite lower weight values, the weakness of the economic foundation and the fragility of the ecological environment has increasingly hampered the improvement of the economic security in the Qinghai-Tibet Plateau. In terms of driving forces, it is the support of the central government and aid programs of other provinces that contributes to its economic development.

Off-Farm Employment and Agricultural Credit Fungibility Nexus in Rural Ghana

This study examined the impact of off-farm employment on rural household agriculture credit fungibility (CF) using survey data collected from four regions in Ghana; however, the study paid more attention to agriculture credit received from different sources. By employing the endogenous switching regression (ESR) model, we solved the endogenous issue of off-farm employment. The econometrics model result revealed that off-farm employment negatively influences the household’s probability of practicing agriculture CF. Our results discovered the importance of off-farm employment on agriculture CF and recommended policy implications capable of alleviating agriculture CF.

When Local Trade-Offs between SDGs Turn Out to Be Wealth-Dependent: Interaction between Expanding Rice Cultivation and Eradicating Malaria in Rwanda

Interactions between SDGs are increasingly mapped and mediating factors that determine whether existing synergies or trade-offs can be identified. However, if and how the wealth status of the concerned population shapes whether SDG interaction constitutes a vicious or virtuous circle is largely overlooked. This article focuses on interaction between SDG2 (nutrition) and SDG3 (health), in particular, the relationship between rice production intensification and the fight against malaria, and thus the role of wealth in explaining the trade-off. This study employed a large-scale survey of rural households (n = 3968) in eastern Rwanda, conducted at a time when a rapid expansion of rice fields co-existed with a strong resurgence of malaria. Logistic regression shows that rice-cultivating households faced significant higher malaria risk, as proxied by fever incidence, confirming the negative externality of agricultural intensification on public health through offering a habitat for vector-borne diseases. Even though rice-cultivating households tend to be higher up the local wealth distribution than those outside the rice sector, its distributional effects are generally biased against the poor. Poorer households outside the rice sector hardly share in the benefits from increased rice production but suffer the consequences in terms of increased malaria risk. The case thus draws attention to the importance of using a distributional lens when analyzing interaction between SDGs locally.

Early life adversity, biological adaptation, and human capital: evidence from an interrupted malaria control program in Zambia

Growing evidence from evolutionary biology demonstrates how early life shocks trigger physiological changes designed to be adaptive in challenging environments. We examine the implications of one type of physiological adaptation - immunity formation - for human capital accumulation. Using variation in early life malaria risk generated by an interrupted disease control program in Zambia, we show that exposure to infectious diseases during the first two years of life can reduce the harmful effects of malaria exposure on cognitive development during the preschool years. These findings suggest a non-linear and trajectory-dependent relationship between early life adversity and human capital formation.

Association between livelihood capital and catastrophic health expenditure among patients with critical illness: a cross-sectional study in rural Shandong, China

OBJECTIVE

The objective of this study is to examine the association between livelihood capital and catastrophic health expenditure (CHE).

DESIGN

Between July and August 2019, a cross-sectional study was conducted in critically ill patients.

SETTING

Shandong, China.

PARTICIPANTS

1041 households with critically ill patients from 77 villages.

PRIMARY AND SECONDARY OUTCOME MEASURES

We defined expenditure as being catastrophic if a household's out-of-pocket payments were greater than or equal to 40% of their capacity to pay. Using the sustainable livelihoods framework, this study explored the associations between CHE and the various forms of livelihood capital-inclusive of human capital, natural capital, physical capital, financial capital and social capital. χ² tests, t-tests, Wilcoxon tests and binary logistic regression analysis were performed to examine these associations.

RESULTS

The incidence of CHE among households with critically ill patients was 76.37% in this study. Better livelihood capital was significantly associated with lower incidence of CHE. After controlling for confounding factors, households with healthier patients (OR 0.47, 95% CI 0.23 to 0.96), more real estate ownership (OR 0.35, 95% CI 0.19 to 0.67) and better economic status (OR 0.33, 95% CI 0.18 to 0.62) were associated with a reduction in the occurrence of CHE.

CONCLUSIONS

Livelihood capital was significantly associated with CHE in rural families with critically ill patients. This association suggests that, in addition to providing health insurance to the critically ill, more attention should be paid to their ability to create and preserve livelihood capital.

Chronic Illness and Income Diversification in Rural China

Off-farm diversification offers an important pathway out of poverty while health-impaired rural farmers can hardly seize the opportunity in developing countries. This paper investigates how chronic illness shapes livelihood structure and income generation in rural China. Our sample consists of 3850 rural households in Southern China and we rely on instrumental variable regressions to identify causal effects. We find that farmers with chronic illness tend to diversify towards local off-farm employments, rather than migrants, since local off-farm employments are more likely to act in a strategically complementary way to farming. Further analysis shows that income returns of diversification tend to be substantially higher for the health-impaired. While the relationship between diversification and income presents a conventional inverted U shape for the healthy, it is best categorized as upward sloping with diminishing marginal effects for farmers with chronic illness.

Averting expenditure on malaria: effects on labour productivity of maize farmers in Bunkpurugu-Nakpanduri District of Ghana

Background

Malaria has been one of the commonest diseases during farming season, which affects farmers’ health resulting in a reduction in the number of days spent on the farm. As a result, farmers are regularly trying to avert malaria infection through preventive measures. Motivated by this argument, this study sought to determine the effects of malaria averting expenditure on labour productivity of maize farmers in Bunkpurugu-Nakpanduri District in the Northern Region of Ghana.

Methods

A cross-sectional primary data was collected from 194 maize farmers. Both descriptive and quantitative data analysis approaches were employed. Conditional mixed process was used to estimate the effects of malaria prevention expenditure on maize farmers’ labour productivity.

Results

The study revealed that maize farmers incurred an average expenditure of GHc284.6 to prevent malaria annually. The result shows that factors that affect maize farmers’ malaria prevention expenditure include off-farm income, household size, presence of bushes around houses, presence of pregnant women and number of household members in school. Meanwhile, quantity of fertilizer, seed, weedicides, farming experience, age, ownership of motorbike and averting expenditure are significant determinants of maize labour productivity. The study revealed that farmers who spend more money to avert malaria attack are more labour productive.

Conclusions

Therefore, this study recommends that Ministry of Health and Ministry of Food and Agriculture should collaborate and integrate health extension service on malaria in agricultural extension to educate farmers on the need to avert malaria. Farmers should be educated on malaria preventive strategies, such as clearing of bushes around houses, draining of stagnant water, sleeping in treated mosquito nets among others. Lastly, aside distribution of free mosquito nets to pregnant women, they should be subsidized and made available to all farmers for malaria prevention.

Potential impact of eradicating malaria on gender inequality within agricultural households in sub-Saharan Africa

The international development community has shown an increased interest in the links between malaria and gender inequality over the past two decades. Working towards the ambitious goal of eradicating malaria by 2040, suppressing the malaria burden could accelerate progress in reducing gender inequality within agricultural households in sub-Saharan Africa. Although numerous studies have examined narrow aspects of the relationship between malaria and gender inequality, little progress has been made in understanding how eliminating malaria could affect gender inequality within agricultural households. This Open Letter focuses on the amount of time women farmers dedicate to caregiving for malaria cases among children in agricultural households, and how reducing time spent on this activity could reduce gender inequalities and impact agricultural productivity. We argue that a research agenda is needed to inform a multi-disciplinary approach to gain this understanding. We conclude by discussing the means through which a reduction in gender inequalities in agricultural households could impact the effectiveness of vector control interventions.

Modelling malaria reduction in a highly endemic country: Evidence from household survey, climate, and program data in Zambia

Substantial efforts have seen the reduction in malaria prevalence from 33% in 2006 to 19.4% in 2015 in Zambia. Many studies have used effect measures, such as odds ratios, of malaria interventions without combining this information with coverage levels of the interventions to assess how malaria prevalence would change if these interventions were scaled up. We contribute to filling this gap by combining intervention coverage information with marginal predictions to model the extent to which key interventions can bring down malaria in Zambia. We used logistic regression models and derived marginal effects using repeated cross-sectional survey data from the Malaria Indicator Survey (MIS) datasets for Zambia collected in 2010, 2012 and 2015. Average monthly temperature and rainfall data were obtained from climate explorer a satellite-generated database. We then conducted a counterfactual analysis using the estimated marginal effects and various hypothetical levels of intervention coverage to assess how different levels of coverage would affect malaria prevalence. Increasing IRS and ITNs from the 2015 levels of coverage of 28.9% and 58.9% respectively to at least 80% and rising standard housing to 20% from the 13.4% in 2015 may bring malaria prevalence down to below 15%. If the percentage of modern houses were increased further to 90%, malaria prevalence might decrease to 10%. Other than ITN and IRS, streamlining and increasing of the percentage of standard houses in malaria fight would augment and bring malaria down to the levels needed for focal malaria elimination. The effects of ITNs, IRS and Standard housing were pronounced in high than low epidemiological areas.

Household Health and Cropland Abandonment in Rural China: Theoretical Mechanism and Empirical Evidence

Prior studies have fully explored the impacts of rural labor migration on land use forms. In contrast to prior studies, this study focuses on the health status of rural households and its quantitative impacts on cropland abandonment (CA). More specifically, under the guidance of the theoretical mechanism of "household health affects CA by labor supply", this study employs survey data from 8031 households collected in 27 Chinese provinces in 2014 to explore the quantitative impacts of household health on CA. The results are as follows. (1) The higher the level of household health is, the less CA there is. (2) Compared with males, the impact of female health status on CA is more obvious. Thus, the relationship between household health and CA matters, not only because it may help to theoretically enhance the understanding of the importance of health in peasant households, but also because it may help to practically provide references for effective policies of CA from the perspective of rural medical services.

Eliminating malaria by 2040 among agricultural households in Africa: potential impact on health, labor productivity, education and gender equality

Background: Ambitious goals have been set to eradicate malaria by the year 2040. Given the high poverty levels and the intense levels of malaria transmission in sub-Saharan Africa, suppressing malaria in rural agricultural communities in these regions will be one of the greatest challenges to achieving malaria eradication. This study has two objectives. The first is to estimate how eradicating malaria by 2040 would affect agricultural households in sub-Saharan Africa. The second is to identify where additional research is needed to develop better estimates of how eradicating malaria by 2040 would affect those households. Methods: Using agricultural census data and malaria morbidity data, we developed estimates of the number of malaria cases in 2018 among agricultural households with fewer than 10 hectares of land for 35 countries in sub-Saharan Africa. By combining these estimates with additional evidence from the literature, we analyzed how achieving malaria eradication by 2040 would affect indicators related to four Sustainable Development Goals: health, poverty, education and gender equality. Results: Our analysis found that achieving malaria eradication by 2040 would prevent approximately 841 million cases of malaria and thereby decrease the number of lost workdays among agricultural households by approximately 3.2 billion days. Eradicating malaria by 2040 would also increase the number of school days attended by children by 1.5 billion days while also reducing the number of caregiving days provided by women for malaria cases by approximately 1.1 billion days. Conclusions: This article analyzes the impact of eradicating malaria among agricultural households in sub-Saharan Africa using indicators related to four of the Sustainable Development Goals. Enhanced data collection efforts related to these four indicators would facilitate more rigorous estimates of how eradicating malaria would affect these indicators over the next two decades.

Potential relationship between malaria elimination and reducing stunting in children in sub-Saharan Africa

Background: The Sustainable Development Goals include goals to reduce malaria and stunting. Stunting is a result of childhood undernutrition. Our previous studies found that suppressing malaria could reduce poverty rates among agricultural households in Africa. The objective of this paper is to highlight how suppressing malaria could have the further effect of reducing stunting rates among children in agricultural households. Methods: We estimated the burden of stunting among children in agricultural households in malarious regions of sub-Saharan Africa on the basis of our previous research and data from UNICEF. We also used an evaluation of the impact of a nutrition program in Peru to assess the potential for poverty reduction to reduce stunting. Results: We estimated that there are approximately 21.5 million children suffering from stunting in agricultural households in malarious regions of sub-Saharan Africa. Poverty reduction was found to be a necessary condition to reduce stunting via a multisectoral nutrition program in Peru. The potential impact of suppressing malaria on the poverty rate of agricultural households could therefore play an important role in nutrition programs aiming to reduce stunting in Africa. Reducing the number of children with stunting in these households would improve their health and productivity as adults. Conclusion: We have developed the first estimates of the burden of stunting in agricultural households in malarious regions of sub-Saharan Africa. Understanding how suppressing malaria affects stunting in these households could affect funding for anti-malaria programs. Future research should use longitudinal data to examine this impact at a finer spatial scale.

Evidence for the impact of malaria on agricultural household income in sub-Saharan Africa

Background: Progress in suppressing malaria over the next two decades may have a significant impact on poverty among agricultural households in sub-Saharan Africa. A recent study found that if malaria were eradicated by 2040, poverty rates among such households would fall by 4 to 26 percentage points more from 2018 to 2040 than if the burden of malaria remained at its current level. The relatively wide range of these estimates is due to a lack of evidence regarding the long-term impact of suppressing malaria on the incomes of agricultural households. The objective of this study is to describe a research framework that would generate the necessary evidence for developing more precise estimates. Methods: First, we developed a conceptual framework for understanding the potential long-term impact of suppressing malaria on the incomes of agricultural households. Next, we established a research framework for examining each component of the conceptual framework. Results: Our proposed research framework enables a comprehensive examination of how malaria affects the decisions, productivity, harvest value and expenditures due to morbidity and mortality within an agricultural household. This contrasts with the 27 existing relevant studies that we have identified, of which 23 focused only on household productivity and expenditures, two focused on decisions, and two focused on harvest values. Conclusion: By implementing the research framework presented in this study, we will increase our knowledge of how suppressing malaria over the next two decades would affect the incomes of agricultural households in sub-Saharan Africa. Evidence generated from the framework will inform funding allocation decisions for malaria elimination initiatives.

Impact of eliminating malaria by 2040 on poverty rates among agricultural households in Africa

Background: Reaching the goal of eradicating malaria by 2040, if achieved, would have a profound effect on farmers’ lives in sub-Saharan Africa. Our objective is to examine how achieving that goal would affect poverty rates of agricultural households. Methods: We analyzed the potential impact of eliminating malaria by 2040 on poverty rates among agricultural households in malarious regions of sub-Saharan Africa. Our model used ten scenarios to examine how the impact of eliminating malaria by 2040 on households’ income would affect the number of individuals living on less than $1.90 (2011 PPP) per day.  Results: We analyzed ten scenarios for malaria’s impact on agricultural household income from 2018 to 2040 for the approximately 324 million individuals in agricultural households in malarious regions of sub-Saharan Africa in 2018. We found that approximately 53 million to 123 million individuals would escape poverty by 2040 if malaria were eliminated by that year. If the malaria burden in agricultural households remained at its current level through 2040, only 40 million individuals would escape poverty by 2040, a decrease of only 24%. Therefore, the impact of eliminating malaria by 2040, relative to the status quo scenario through 2040, is that approximately 13 million to 84 million individuals in agricultural households will escape poverty.  Conclusions: The modeling analysis presented here is meant to be a starting point for additional research into the potential impact of eliminating malaria on the incomes of agricultural households in sub-Saharan Africa. This study could be strengthened with the application of new methods to examine malaria’s impact on the welfare of agricultural households. We recommend the collection and analysis of longitudinal data from agricultural households in future studies of malaria’s impact on these households.

The impact of packaging and messaging on adherence to malaria treatment: Evidence from a randomized controlled trial in Uganda

Despite substantial public and private costs of non-adherence to infectious disease treatments, patients often do not finish their medication. We explore adherence to medication for malaria, a major cause of morbidity and health system costs in Africa. We conducted a randomized trial in Uganda testing specialized packaging and messaging, designed to increase antimalarial adherence. We find that stickers with short, targeted messages on the packaging increase adherence by 9% and reduce untaken pills by 29%. However, the currently used method of boosting adherence through costly, specialized packaging with pictorial instructions had no significant impacts relative to the standard control package. We develop a theoretical framework of the adherence decision, highlighting the role of symptoms, beliefs about being cured, and beliefs about drug effectiveness to help interpret our results. Patients whose symptoms resolve sooner are substantially less likely to adhere, and the sticker interventions have the strongest impact among these patients.

Effect of providing near glasses on productivity among rural Indian tea workers with presbyopia (PROSPER): a randomised trial

BACKGROUND

Presbyopia, age-related decline in near vision, is the most common cause of vision impairment globally, but no trials have assessed its workplace effects. We aimed to study the effect of near glasses on the productivity of tea workers with presbyopia.

METHODS

This randomised trial was done in tea pickers aged 40 years or older in Assam, India, with unaided near visual acuity (NVA) lower than 6/12 in both eyes, correctable to 6/7·5 with near glasses; unaided distance vision 6/7·5 or greater; and no eye disease. Participants were randomly assigned (1:1) to receive free glasses optimising NVA at working distance (cost including delivery US$10·20 per person), either immediately (intervention group) or at closeout (control group). Participants were stratified by age, sex, and productivity. The primary outcome (investigator-masked) was the difference between groups in the change in mean daily weight of tea picked (productivity), between the 4-week baseline period (June, 2017) and the 11-week evaluation period (July 24, 2017, to Oct 7, 2017). Workers' income was tied to their productivity. Compliance with study glasses was assessed at seven unannounced visits. Results were analysed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT03228199.

FINDINGS

Between July 3, 2017, and July 15, 2017, 1297 (48·1%) of 2699 permanent workers met the age criteria and consented for eye examinations. 751 (57·9%) fulfilled vision criteria and were randomly assigned to the intervention (n=376) or control (n=375) groups. Groups did not differ substantially in baseline characteristics. No participants owned glasses at baseline, 707 (94·1%) received the allocated intervention, and all were followed up and analysed. Between the baseline and evaluation periods, mean productivity in the intervention group increased from 25·0 kg per day to 34·8 kg per day (an increase of 9·84 kg per day), a significantly higher increase than in the control group (from 26·0 kg per day to 30·6 kg per day; an increase of 4·59 kg per day), corresponding to a between-group difference of 5·25 kg per day (95% CI 4·50-5·99; 21·7% relative productivity increase; effect size 1·01 [95% CI 0·86-1·16]; p<0·0001). Intervention-group compliance with study glasses reached 84·5% by closeout. Regression model predictors of greater productivity increase included intervention group membership (5·25 kg per day [95% CI 4·60-5·91], p<0·0001) and, among intervention participants, older age (p=0·039) and better compliance with the intervention (p<0·0001).

INTERPRETATION

A substantial productivity increase was achieved in this rural cohort by providing glasses to correct presbyopia, with little cost and high intervention uptake.

FUNDING

Clearly.

Eliminating malaria by 2040 among agricultural households in Africa: potential impact on health, labor productivity, education and gender equality

Background: Ambitious goals have been established to eradicate malaria by the year 2040. Suppressing malaria in rural agricultural communities in sub-Saharan Africa represents one of the greatest challenges to achieving malaria eradication given the poverty and high intensity of malaria transmission in these regions. The objective of this study is to examine how suppressing malaria among smallholder agricultural households in sub-Saharan Africa over the next two decades will affect progress towards achieving the Sustainable Development Goals.Methods: Using agricultural census data and malaria morbidity data, we developed estimates of the number of malaria cases among smallholder agricultural households for each country in sub-Saharan Africa. Using these estimates as well as additional data from the literature, we analyzed how achieving malaria eradication by 2040 would affect indicators related to four Sustainable Development Goals: health, poverty, education and gender equality.Results: Our analysis found that achieving malaria eradication would prevent approximately 1 billion malaria cases and thereby decrease the number of lost work-days among agricultural households due to malaria morbidity by approximately 3.8 billion days. Eradicating malaria by 2040 would also increase the number of school days attended by children by 4.5 billion days while also reducing the number of caregiving days by women for malaria cases by approximately 1.9 billion days.Conclusions: This article analyzed the impact of eradicating malaria among smallholder agricultural households in sub-Saharan Africa in terms of four of the Sustainable Development Goals. Greater recognition of the non-health benefits of achieving malaria eradication could catalyze the agricultural sector to intensify their contributions to eradicating malaria.

Exploring the use of routinely-available, retrospective data to study the association between malaria control scale-up and micro-economic outcomes in Zambia

BACKGROUND

Country-level evidence on the impact of malaria control on micro-economic outcomes is vital for mobilizing domestic and donor resources for malaria control. Using routinely available survey data could facilitate this investigation in a cost-efficient way.

METHODS

The authors used Malaria Indicator Surveys (MIS) and Living Conditions Monitoring Survey (LCMS) data from 2006 to 2010 for all 72 districts in Zambia to relate malaria control scale-up with household food spending (proxy for household well-being), educational attainment and agricultural production. The authors used two quasi-experimental designs: (1) a generalized propensity score for a continuous treatment variable (defined as coverage from owning insecticide-treated bed nets and/or receipt of indoor residual spraying); and, (2) a district fixed effects model to assess changes in the outcome relative to changes in treatment pre-post scale-up. The unit of analysis was at district level. The authors also conducted simulations post-analysis to assess statistical power.

RESULTS

Micro-economic outcomes increased (33% increase in food spending) concurrently with malaria control coverage (62% increase) from 2006 to 2010. Despite using data from all 72 districts, both analytic methods yielded wide confidence intervals that do not conclusively link outcomes and malaria control coverage increases. The authors cannot rule out positive, null or negative effects. The upper bound estimates of the results show that if malaria control coverage increases from 60 to 70%, food spending could increase up to 14%, maize production could increase up to 57%, and years of schooling could increase up to 0.5 years. Simulations indicated that the generalized propensity score model did not have good statistical power.

CONCLUSION

While it is technically possible to use routinely available survey data to relate malaria control scale-up and micro-economic outcomes, it is not clear from this analysis that meaningful results can be obtained when survey data are highly aggregated. Researchers in similar settings should assess the feasibility of disaggregating existing survey data. Additionally, large surveys, such as LCMS and MIS, could incorporate data on both malaria coverage and household expenditures, respectively.

Why is malaria associated with poverty? Findings from a cohort study in rural Uganda

BACKGROUND

Malaria control and sustainable development are linked, but implementation of 'multisectoral' intervention is restricted by a limited understanding of the causal pathways between poverty and malaria. We investigated the relationships between socioeconomic position (SEP), potential determinants of SEP, and malaria in Nagongera, rural Uganda.

METHODS

Socioeconomic information was collected for 318 children aged six months to 10 years living in 100 households, who were followed for up to 36 months. Mosquito density was recorded using monthly light trap collections. Parasite prevalence was measured routinely every three months and malaria incidence determined by passive case detection. First, we evaluated the association between success in smallholder agriculture (the primary livelihood source) and SEP. Second, we explored socioeconomic risk factors for human biting rate (HBR), parasite prevalence and incidence of clinical malaria, and spatial clustering of socioeconomic variables. Third, we investigated the role of selected factors in mediating the association between SEP and malaria.

RESULTS

Relative agricultural success was associated with higher SEP. In turn, high SEP was associated with lower HBR (highest versus lowest wealth index tertile: Incidence Rate Ratio 0.71, 95 % confidence intervals (CI) 0.54-0.93, P = 0.01) and lower odds of malaria infection in children (highest versus lowest wealth index tertile: adjusted Odds Ratio 0.52, 95 % CI 0.35-0.78, P = 0.001), but SEP was not associated with clinical malaria incidence. Mediation analysis suggested that part of the total effect of SEP on malaria infection risk was explained by house type (24.9 %, 95 % CI 15.8-58.6 %) and food security (18.6 %, 95 % CI 11.6-48.3 %); however, the assumptions of the mediation analysis may not have been fully met.

CONCLUSION

Housing improvements and agricultural development interventions to reduce poverty merit further investigation as multisectoral interventions against malaria. Further interdisplinary research is needed to understand fully the complex pathways between poverty and malaria and to develop strategies for sustainable malaria control.