Is malaria illness among young children a cause or a consequence of low socioeconomic status? evidence from the united Republic of Tanzania

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Malaria is commonly considered a disease of the poor, but there is very little evidence of a possible two-way causality in the association between malaria and poverty. Until now, limitations to examine that dual relationship were the availability of representative data on confirmed malaria cases, the use of a good proxy for poverty, and accounting for endogeneity in regression models. Methods A simultaneous equation model was estimated with nationally representative data for Tanzania that included malaria parasite testing with RDTs for young children (six-59 months), and accounted for environmental variables assembled with the aid of GIS. A wealth index based on assets, access to utilities/infrastructure, and housing characteristics was used as a proxy for socioeconomic status. Model estimation was done with instrumental variables regression. Results Results show that households with a child who tested positive for malaria at the time of the survey had a wealth index that was, on average, 1.9 units lower ( p -value < 0.001), and that an increase in the wealth index did not reveal significant effects on malaria. Conclusion If malaria is indeed a cause of poverty, as the findings of this study suggest, then malaria control activities, and particularly the current efforts to eliminate/eradicate malaria, are much more than just a public health policy, but also a poverty alleviation strategy. However, if poverty has no causal effect on malaria, then poverty alleviation policies should not be advertised as having the potential additional effect of reducing the prevalence of malaria.

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Published 01 January 2012
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de Castro and FisherMalaria Journal2012,11:161 http://www.malariajournal.com/content/11/1/161
R E S E A R C HOpen Access Is malaria illness among young children a cause or a consequence of low socioeconomic status? evidence from the united Republic of Tanzania 1* 2* Marcia Caldas de Castroand Monica G Fisher
Abstract Background:Malaria is commonly considered a disease of the poor, but there is very little evidence of a possible twoway causality in the association between malaria and poverty. Until now, limitations to examine that dual relationship were the availability of representative data on confirmed malaria cases, the use of a good proxy for poverty, and accounting for endogeneity in regression models. Methods:A simultaneous equation model was estimated with nationally representative data for Tanzania that included malaria parasite testing with RDTs for young children (six59 months), and accounted for environmental variables assembled with the aid of GIS. A wealth index based on assets, access to utilities/infrastructure, and housing characteristics was used as a proxy for socioeconomic status. Model estimation was done with instrumental variables regression. Results:Results show that households with a child who tested positive for malaria at the time of the survey had a wealth index that was, on average, 1.9 units lower (pvalue<0.001), and that an increase in the wealth index did not reveal significant effects on malaria. Conclusion:If malaria is indeed a cause of poverty, as the findings of this study suggest, then malaria control activities, and particularly the current efforts to eliminate/eradicate malaria, are much more than just a public health policy, but also a poverty alleviation strategy. However, if poverty has no causal effect on malaria, then poverty alleviation policies should not be advertised as having the potential additional effect of reducing the prevalence of malaria. Keywords:Malaria, Poverty, Conceptual framework malariapoverty causality
Background Malaria is commonly considered a disease of poverty [13]. Recent Demographic and Health Survey (DHS) data for the United Republic of Tanzania (from now on referred to as Tanzania), illustrate this relationship at the individual child level (Figure 1). The observed negative correlation between malaria and socioeconomic status (SES) may indicate that malaria infections cause low SES (e.g. ill workers are less productive), or that poverty increases the risk of malaria transmission (e.g. the poor
* Correspondence: mcastro@hsph.harvard.edu; monica.fisher@oregonstate. edu 1 Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Bldg, I, Room 1113, Boston, MA 02115, USA 2 Agricultural and Resource Economics Department, Oregon State University, Ballard Extension Hall Room 218, Corvallis, OR 97331, USA
are less able to afford malaria preventative measures). Also, there may be incidental associations, such as, improvements in road infrastructure in a region could simultaneously increase household incomes (e.g. through improved market access) and reduce malaria incidence (e.g. through better access to health care facilities). Understanding whether the malariapoverty correlation implies causality and, if it does, the direction of causality, has crucial implications for malaria control efforts, such as the Roll Back Malaria (RBM) and the Presidents Mal aria Initiative (PMI), and for the recent call for malaria elimination, with the ultimate goal of malaria eradication [4]. If a bidirectional link exits between malaria and SES, then (i) poverty alleviation policies (e.g. income re distribution, job creation, and educational investment)
© 2012 de Castro and Fisher; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.