Malaria Eradication and Economic Outcomes in Sub-Saharan Africa: Evidence from Uganda

RATIONALE:The damage that malaria inflicts on population health is severe and well established. With an estimated 350 to 500 million cases and over one million deaths per year, malaria represents a major threat to 3.3 billion people in over 100 nations. Sub-Saharan Africa (SSA) bears the vast majority of the global malaria burden, with 71% of cases and 86% of deaths. It is estimated that anywhere from 30% to 50% of outpatient visits and hospital admissions in this region are a result of malaria illness, with severe cases leading to complications including anemia, seizures, coma, and death. Previous evidence outside of SSA (Cutler, et al, 2010; Bleakley, 2010; Lucas, 2010) indicates that exposure to malaria in childhood has significant long-run benefits. However, these results may not be generalizable to SSA because the malaria strain prevalent there produces much higher mortality than malaria in other regions.

OBJECTIVES: In this paper, we exploit quasi-experimental variation in childhood malaria exposure by examining the impact of a 1959-1960 eradication campaign in southerwestern Uganda. The effort constitutes a rare attempt to eliminate malaria in sub- Saharan Africa and produced an immediate and large disease reduction. We utilize this health shock to explore changes in adult educational and economic outcomes, comparing the intervention district to the rest of Uganda.

METHODS: During the years of 1959 and 1960, a program of DDT spraying and mass distribution of antimalarial medication rapidly interrupted disease transmission, producing variation in childhood malaria exposure by birth cohort. To identify the impact of malaria eradication, we employ a difference-in-difference methodology to compare changes in outcomes for the intervention district against changes in the rest of Uganda. The 1991 Uganda national census is used.

RESULTS:Our primary result shows that malaria eradication produced 0.3 more years of schooling in the intervention area compared to the rest of Uganda. This treatment effect represents a gain in schooling of 10% and 5% for males and females respectively and translates into a 3% to 11% overall income gain, depending on the rate of return to education assumed. We also find statistically significant improvements in primary-school completion and literacy, although the former effect constitutes a 50% increase, while the latter does not represent an economically important change. Importantly, we find that these educational effects are larger in areas with higher pre-treatment malaria incidence, as expected. Finally, we construct an asset-index to proxy for household socioeconomic status and find suggestive increases in this measure of income.

CONCLUSIONS: Aid to low- and middle-income nations for malaria control has increased from $230 million to 1.86 billion between 2000 and 2010 (IHME, 2012). However, even though this funding expansion has produced the most ambitious malaria control program since the original WHO initiative in 1955, evidence on the potential long-term economic impact in SSA remains relatively scant. These results therefore provide the best guidance available on the economic effect of malaria control in the region with the largest current burden.