Economic and demographic research on malaria: a review of the evidence.

The primary objective of malaria control is to reduce deaths and illness from the disease. Elimination of infection is far more difficult. However, in most developing countries where malaria is endemic, there are few reliable data on levels, differences and trends in malaria mortality, and its relative importance as a cause of death or illness in endemic communities. The large-scale efforts and resources being devoted to delivery of essential care to mothers and young children in most countries make it important to have a better understanding of the extent of cause-specific child mortality levels in different epidemiological conditions so that appropriate interventions can be targeted at high risk groups and properly evaluated according to their contribution to mortality reduction. As per capita resources necessary in relation to the scale of the problem remain scarce, governments are finding that they must use their available resources more efficiently in meeting their health objectives. In the case of malaria, there are far too few empirical data documenting the marginal costs and benefits of alternative interventions and their response to an expansion (or contraction) of services, and to the level of endemicity and distribution of disease. Equally important, the literature on private costs of malaria (treatment, transportation etc) provides incomplete guidance to gains from control unless the authors begin to examine the policy implications of their results; for example, in many countries there is accumulating evidence that private expenditures outweigh public expenditures on health. What effect does this mix have on infectious diseases like malaria where public sector expenditures on prevention are so important in affecting incidence?