Progress & ImPact serIes - Roll Back Malaria - World Health ...

chapter I
IntroductIon: MalarIa outsIde
of afrIca Is a dIsease of poverty
that poses unIque challenges for
control
Malaria exacts a heavy toll in Asia, the Pacific, Americas, Middle East, and Europe. While the
disease burden is heaviest in Africa, outside of Africa there are 51 countries where malaria is a very
real public health problem that threatens many, especially the poor and marginalized. The disease
negatively affects family income due to lost income and payment for treatment. It affects business
due to direct costs of lost production, absenteeism, and prevention and treatment. The biology of
the parasite, the mosquito vectors, and the human population at risk are considerably more diverse
outside Africa, thus presenting a range of unique challenges.
While Africa is widely understood to carry the
major burden of malaria, the disease constitutes
a significant public health problem in 51 countries
elsewhere in the world where it is inextricably
linked with poverty (Figure 1.1).
Poorer populations are more likely to be exposed
to malaria-carrying mosquitoes because they are
more likely to live in rural areas in housing that
offers little protection against mosquitoes and
they are less likely to have access to mosquito
nets or indoor residual spraying of insecticides
(IRS). They also tend to live further away
from health facilities that can offer effective
diagnostic testing and treatment and to be less
able to afford quality treatment.
An episode of malaria reduces the days
worked not only of the infected but of those
that care for them. The Indian Commission on
Macroeconomics and Health notes that, in India,
13 household person-days per patient were
lost per episode of malaria. Furthermore, the
commission estimated that the overall monetary
losses to families (income losses together with
treatment expenses) could amount to between
200 and 400 Indian rupees (US$ 3.5 to 7) (1). The
poorest 10% of the Indian population rely on
sales of their assets or on borrowing to pay for
health-care services, reducing a family's ability
to access basic goods and affecting their longterm
economic prospects.
DeFeATIng MAlARIA In ASIA, THe PACIFIC, AMeRICAS, MIDDle eAST AnD eURoPe
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