Efficacy and cost-effectiveness of environmental management for malaria control

Jürg Utzinger, Yesim Tozan, Burton H. Singer

Research output: Contribution to journalArticle

Abstract

Roll back malaria (RBM) aims at halving the current burden of the disease by the year 2010. The focus is on sub-Saharan Africa, and it is proposed to implement efficacious and cost-effective control strategies. But the evidence base of such information is scarce, and a notable missing element is the discussion of the potential of environmental management. We reviewed the literature and identified multiple malaria control programmes that incorporated environmental management as the central feature. Prominent among them are programmes launched in 1929 and implemented for two decades at copper mining communities in Zambia. The full package of control measures consisted of vegetation clearance, modification of river boundaries, draining swamps, oil application to open water bodies and house screening. Part of the population also was given quinine and was sleeping under mosquito nets. Monthly malaria incidence rates and vector densities were used for surveillance and adaptive tuning of the environmental management strategies to achieve a high level of performance. Within 3-5 years, malaria-related mortality, morbidity and incidence rates were reduced by 70-95%. Over the entire 20 years of implementation, the programme had averted an estimated 4173 deaths and 161 205 malaria attacks. The estimated costs per death and malaria attack averted were US$ 858 and US$ 22.20, respectively. Over the initial 3-5 years start-up period, analogous to the short-duration of cost-effectiveness analyses of current studies, we estimated that the costs per disability adjusted life year (DALY) averted were US$ 524-591. However, the strategy has a track record of becoming cost-effective in the longer term, as maintenance costs were much lower: US$ 22-92 per DALY averted. In view of fewer adverse ecological effects, increased sustainability and better uses of local resources and knowledge, environmental management - integrated with pharmacological, insecticidal and bednet interventions - could substantially increase the chances of rolling back malaria.

Original languageEnglish (US)
Pages (from-to)677-687
Number of pages11
JournalTropical Medicine and International Health
Volume6
Issue number9
DOIs
StatePublished - 2001

Fingerprint

Malaria
Cost-Benefit Analysis
Costs and Cost Analysis
Quality-Adjusted Life Years
Mosquito Nets
Zambia
Knowledge Management
Quinine
Cost Control
Body Water
Wetlands
Africa South of the Sahara
Incidence
Rivers
Copper
Oils
Maintenance
Pharmacology
Morbidity
Mortality

Keywords

  • Cost-effectiveness
  • Efficacy
  • Environmental management
  • Integrated control
  • Malaria
  • Roll Back Malaria

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Parasitology
  • Immunology

Cite this

Efficacy and cost-effectiveness of environmental management for malaria control. / Utzinger, Jürg; Tozan, Yesim; Singer, Burton H.

In: Tropical Medicine and International Health, Vol. 6, No. 9, 2001, p. 677-687.

Research output: Contribution to journalArticle

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