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.