Cost-effectiveness of malaria control in sub-Saharan Africa

Abstract

C A Goodman and colleagues1Goodman CA Coleman PG Mills AJ Cost-effectiveness of malaria control in sub-Saharan Africa.Lancet. 1999; 354: 378-385Summary Full Text Full Text PDF PubMed Scopus (197) Google Scholar provide an excellent analysis of the cost-effectiveness of interventions such as bednets, residual spraying, and improved treatment in lowering the burden of malaria in sub-Saharan Africa. Unfortunately, they fail to observe that the resurgence of malaria in many African countries is caused by the lack of environmental health services, poorly planned and managed dams and irrigation projects,2Lerer LB Scudder T Health impacts of large dams.Environ Impact Assess Rev. 1999; 19: 113-123Crossref Scopus (114) Google Scholar and the absence of cross-border eradication efforts. No discussion of the cost-effectiveness of malaria control is complete without mention of the catastrophic impact of externally imposed macro-economic and health-sector reform.3Garfield R Malaria control in Nicaragua: social and political influences on disease transmission and control activities.Lancet. 1999; 354: 414-418Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar The medicalisation of malaria may blind us to the fact that developed countries protect communities, not by secondary prevention and treatment, but through creating environmental conditions that kill the mosquito vector. It is sad to note that in the early 1960s, WHO believed that with sufficient resources, malaria in Africa could be eradicated. The virtual collapse of services for water, sanitation, and waste control resulted in the return of malaria to periurban areas in Africa, which had previously been regarded as malaria-free zones. Rather than resign ourselves to the belief that regions such as sub-Saharan Africa have an intractable legacy of natural-resource degradation, conflict, economic decline, and social disruption, we have to consider the cost-effectiveness of sustainable interventions such as improvements in infrastructure, the provision of safe water and waste removal services, and better living conditions.4Sachs JD Growth in Africa: it can be done.The Economist. June 29, 1996; : 23-25Google Scholar Insecticides and drugs will never permanently roll back malaria in sub-Saharan Africa. To achieve true malaria control, we need to ensure that the most vulnerable regions are vigorously and equitably developed.