Malaria attributable morbidity and mortality is responsible for more than 210 millions cases and almost half a million deaths per year, the majority of which occur in low and middle-income countries (LMIC). Most malaria cases and deaths occur in the shadow of poverty and co-morbid disease, all factors that may limit a child’s ability to build human capital and achieve developmental freedoms. The aim of this three paper dissertation is to ascertain the impact of malaria on school attendance, health related quality of life and household economy as proxies for three aspects of human development: education, health, and income. An additional aim of the dissertation was to explore the challenges of obtaining reliable data in low resource settings, outside the bounds of a randomized trial, to suggest what methods and measures might increase or constrain studies in LMIC.
The first study employed a retrospective quasi-experimental design to analyze the impact of a home based malaria intervention on school attendance in primary school-aged children in an area of moderate to high malaria prevalence in Kenya. We analyzed and compared data obtained from existing administrative records, school attendance registers, in a pre –post difference in differences design. We used several analytic techniques, OLS, GEE, and mixed effects augmented by imputation to triangulate on our results.
In the second study, we used interviews and short surveys of parents and caregivers of 64 children age 4 months – 13 years, with confirmed malaria to measure the effect of the disease on the health related quality of life of children in rural western Kenya. We collected information from a parent or caregiver during two taped interviews conducted, (1) at the clinic/hospital at the time of receiving medical care, (2) in person or by mobile phone 5-7 days after evaluation and treatment at the health facility. We gathered information on the child’s baseline health prior to the current illness and quality of life from illness through recovery, such as the ability to play, go to school, or participate in normal activities.
In our third study we measured the impact of malaria on household economy in rural western Kenya. The indirect costs of malaria have been well documented in the literature. However, losses to households have typically focused on the contribution of adult productivity alone. We explored the possibility that families living near or at the absolute poverty line might display different behaviors and preferences in order to best support the entire family, not just the ill child.
In a linear panel regression, significant inputs to total household costs in Ksh were total out of pocket costs, pre-hospital payment for medicinal herbs, and lost parental income, while age and gender of the child, and distance from the health facility were not significant. In our sample, 11% of all families used herbs prior to bringing the child to the hospital, paying an average cost of 280 Ksh, over 90% of the cost of a full pediatric course of artemether/lumefantrine. Use of herbs was also significantly associated with a longer period of time between onset of symptoms and presenting to the hospital for diagnosis and treatment (Pearson χ2 136.500, P > 0.000).
Total costs for this single treated episode of malaria represented 34% (SD 0.24) of median monthly household consumption (a proxy for income), which constitutes a catastrophic cost to households.
Taken in total, our findings suggest that in some endemic areas, malaria infections in children can constitute a poverty trap.
The knowledge derived from this work can be applied to cost effectiveness evaluations of malaria interventions, and when designing and implementing poverty reduction programs in malaria affected areas. We hope that this dissertation, including the first known study to assign value to the lived experience of malaria via Patient Reported Outcome Measures, will provide a deeper understanding of the course of malaria, quality of life of affected children and families, and the challenges they face to access medical care, gain an education, and maintain a home. (Abstract shortened by ProQuest.)
|Advisor:||Perloff, Jennifer N.|
|Commitee:||Hamel, Mary J., Kammerer, Nina Cornelia, Nandakumar, Allyala Krishna|
|School:||Brandeis University, The Heller School for Social Policy and Management|
|Department:||The Heller School for Social Policy and Management|
|School Location:||United States -- Massachusetts|
|Source:||DAI-B 77/11(E), Dissertation Abstracts International|
|Subjects:||African Studies, Social research, Economic theory, Public health|
|Keywords:||Attendance, Household costs, Kenya, Mixed methods, Pediatric malaria, Quality of life|
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