Challenges

Chicken and Egg

Malaria is a disease of poverty; countries with the lowest GNP per capita (light colored in top graph) have the most malaria (dark colored in the bottom graph). This works in both directions. Malaria continues to be transmitted in countries where poverty limits the public and private resources necessary for its control. And, malaria illness limits the productivity of the population and contributes to the poverty, both at the household level and for the country as a whole.

Courtesy CDC.

Malaria and Malnutrition

Malaria causes malnutrition. Why? The poorest people live literally from hand to mouth. Most work for a living. The only source of food today, let alone tomorrow - for themselves and their children - is what they earn today.

No work, no money. No money, no food. That's why malaria hits the poorest people the hardest. Their 'capital' is their body. Their labor translates into capital daily.

If they are sick today, their nutrition drops today. If they have saved something back, then malnutrition may start tomorrow.

Malnutrition worsens malaria. If they are malnourished today, the hangover from malaria may lower their productivity tomorrow.

The average caloric intake for many of these people is under 1000 calories a day in good times. Malaria, on average, eliminates one work day in ten for adult males. The 1000 calories is an average. 2-300 calorie days are common.

When kids have malaria, they can't eat. They expel what is in their system. When kids get malaria all bodily resources go toward keeping the child alive, not digestion. What remains in the stomach doesn't get absorbed.

Malaria continues to be transmitted in countries where poverty limits the public and private resources necessary for its control. And, malaria illness limits the productivity of the population and contributes to the poverty, both at the household level and for the country as a whole.

 

Another Virtuous Cycle

Mosquito nets help to set a floor under poverty. Deliver nets to a village and we slow malaria. Slow malaria and someone may eat tonight. With luck, in a few weeks, there may be something to eat at noon, too. Benefits compound.

Mosquito nets may save a life, yes. More important could be that the
mosquito net helps Mum and Dad provide dinner. The kids can absorb what they are fed. Less sickness and better nutrition may set off a cycle of better ability to work, more food and better nourishment.

Be sure to mention HIV and 3x5.

Systemic Help

Why focus on Malaria? Malaria is a key to these problems. Malaria is the lynchpin, because malaria causes poverty. Malaria makes people sick, kills children, burdens hospitals, and saps the economy. It drains energy from individuals and the whole system. Malaria halts progress. We can make a dent in Malaria.

Dealing with many diseases swamps the health care systems in Sub-Saharan Africa. Providing ITNs to an area has been proven by repeated studies to lower the number of hospital visits by 25-40%. What effect on HIV/AIDS treatment would freeing up 25-40% of the resources of hospitals have on the systemic capacity to deal with HIV/AIDS?

Prevention

People with malaria who are exposed to HIV are more likely to get HIV/AIDS. When you lower malaria rates you also lower transmission of HIV/AIDS. Insecticide treated nets prevent half of the cases of malaria. The incremental costs of ITNs are so small that providing ITNs could be the most cost effective way to prevent HIV/AIDS. Not the only way, but a useful addition to the arsenal.

See the article on Malaria and HIV at Massive Effort (from the BBC News)

What is the value of preventing a single case of HIV/AIDS, now? How about a few thousand cases? A few hundred thousand cases?

Cost of Treatment

The value of treating a case of HIV/AIDS is how much, now?

The cost of mosquito nets is under $5. Providing ITNs to all children in Sub-Saharan Africa would be well under $500 million. Tens of millions of ITNs are already in place, so the annual costs would be closer to $100 million, much of which is already funded. Providing ITNs for HIV/AIDS patients could be a huge boon to their treatment and survival.

Prevention of Death from HIV/AIDS

The immediate cause of death for HIV/AIDS patients is often malaria. A person who is immunocompromised gets malaria more easily than the regular person. A case of malaria for a person who is immunocompromised is more likely to be lethal. There are 3-500,000,000 cases of malaria each year, mostly in Africa. That number could be cut in half from distribution of ITNs alone. How many lives would ITNs save from HIV/AIDS?

Delay of Death is Increasingly Important

As medicines improve and distribution improves, delaying death becomes increasing important to keep the patients alive until medicines do arrive. What value would a $3 net be? For many, possibly the difference between life and death.

 

last updated 25 May 2006