In the dead of the night, a single parent, Mama Tobe is utterly helpless. 10 months old Tobe cries hysterically with boiling point temperature. He could practically boil water if dropped in her badly beaten water pot. She had considered the option not because she was a murderer but out of sheer frustration. She was out of money and he was not getting any better after 3 days. She prayed silently for his healing as she used cold wet towel to mop his scorching body. The impenetrable darkness and torrid heat added to the large desperate mosquitoes that sang in her ears and took painful drags of her blood amidst slaps on her red sore body already dripping with sweat. Rejecting milk and crying so hard, Mama Tobe is afraid, reaches her limit and rushes out into the thick darkness at 1 am heading for Sisi Nnenna’s house, the community Nurse that had birthed Tobe without thinking of the consequences of meeting dark forces rumoured to roam the tiny street after dark. But it was already too late for her little joy. Tobe had gone into seizure on getting to Sisi Nnenna’s doorstep. Her only hope was gone.

Mama’s Tobe’s story might not be so different from several heart wrenching stories of households in sub Saharan Africa that have lost their U5 children to the malaria endemic that plaques the region mostly because of low household income/poverty and low access to affordable and adequate health services. It is almost inconceivable that there are Malaria-free countries where households and Governments benefit largely on several fronts.

The questions therefore should be, if it is possible to have a Malaria-free State, why not the sub Saharan African countries? What really is the real cost of the malaria endemic? What are the economic values of lives lost? What are the actual and opportunity costs for the government to provide an adequate health system? What does it costs the household and healthcare providers?

The World Health Organization reports that malaria accounts for nearly one million deaths each year in Africa; an estimated 700,000 of these deaths are among under 5 children. In other reports, malaria is a major cause of morbidity and mortality in sub Saharan African countries, directly contributing to poverty, low productivity, and reduced school attendance. While it is not a hidden fact that the region in itself helps the spread of the disease because of the ecological factor and trifling health infrastructures, one often wonder why health budgets, donated funds and countless programs initiated to combat the menace yield so little results. Again, the issue of corruption and mismanagement of funds surfaces, making the dream of having a Malaria-free country a friendly illusion.

According to the findings of a new report released by the World Health Organization, Harvard University and the London School of Hygiene and Tropical Medicine, Africa’s GDP would be up to $100 billion greater if malaria had been eliminated 3 decades ago. The report said that Malaria-free countries average three times higher GDP per person than malarious countries, even after controlling for government policy, geographical location, and other factors which impact on economic well-being. These countries are among the very poorest in the world and are often characterized with very low rates of economic growth. The saying 'health is wealth' takes full precedence here.

There is no doubt that the control of the prevalence of malaria in Sub-Saharan Africa would greatly increase the continent's economic productivity and the income of most household by saving costs and increasing investments. Malaria has vast potentials of impeding flows of trade, foreign investment, and commerce as Tourists and multinational firms shun regions with high malaria. According to the Strategic Plan for malaria Control in Nigeria 2009-2013, there are a total of 70-110 million clinical cases and 300,000 (285,000-331,000) deaths among children under 5 years of age, accounting for about 30% of deaths in this age group. Malaria is also responsible for an estimated 11% of maternal mortality. The disease’s economic impact is enormous with about $880 million lost to malaria annually in the forms of treatment costs, prevention and loss of man hours among others. It is certain malaria exerts a significant economic burden on healthcare providers and households.

A recent malaria Journal "The economic costs of malaria in children in three sub-Saharan countries: Ghana, Tanzania and Kenya" identified economic cost estimations for a single malaria episode in terms of the household costs, opportunity cost implication, the cost of primary health workers and government programs put in place to combat malaria among others. It used the severity, co-morbidities and medium-term consequences to estimatee the economic burden of malaria in U5 children while recommending the introduction of new prophylactic measures, improved current strategies for malaria control and redesigned scaling up of both new and old efficacious interventions to reduce the malaria menace in the region.

The Journal clearly reveals the economic burden of malaria in U5 children on the household and health system, the costs of treatment per malaria episode by severity, presence of co-morbidities and clinical complications, expected treatment cost per episode per child and the annual economic costs of preventing and treating malaria with measurable indices gathered from records, interviews and scenarios.

In the study, the total costs for treating a malaria episode were estimated for uncomplicated malaria, malaria hospitalization and severe anemia, cerebral malaria and neurological sequelae. Conclusive results showed that the total costs per malaria episode (including direct and indirect household costs and health system costs) based on disease severity and the presence of complication and co-morbidities ranged from US$ 7.99 to $ 229.24 in Ghana, from US$ 5.2 to $ 137.74 in Tanzania, and from US$ 11.24 to $ 287.81 in Kenya. It showed on the average that an overall cost borne by households in Ghana and Tanzania is 55 per cent and 70 per cent in Kenya.

Most of household costs are made of indirect costs (85%) in Tanzania and in Kenya while this proportion falls to about half (46%) in Ghana. This suggests that Ghana households need to support much more direct costs than in the two other countries of the study due to more expensive treatment and higher medical service costs, which include high health personnel salary regardless of severity. Note that direct costs are costs related to hospitalization (including facilities and personnel) and the cost of the resources used for treatment (tests and medications) while indirect costs includes the carer's reported productivity loss for the entire episode of malaria.

Generally, in sub Saharan African countries – Nigeria inclusive, a larger percentage of households do not have health insurance and as such bear full burden of costs of health care. However, the study while revealing that health insurance cardholders accounted for 7 per cent of the population in 2005 and 45 per cent of the population in 2008 in Ghana, there was minor effect on the results despite the increased percentage. The same can be said for Tanzania, Kenya and Nigeria.

Governments in sub Saharan African countries should therefore as a matter of urgency increase streamlined efforts targeted at eradicating the disease on long term while it continues to expand coverage and use of insecticide treated bed nets (ITNs), particularly among vulnerable groups of pregnant women and children under 5 years of age. The situation is still dire in Nigeria and has adversely affected developmental efforts at all tiers of government and households not withstanding donor funds and prevention and treatment costs included in national annual costs of malaria to represent the total cost for malaria pushed into the menace with hopes of achieving the Millennium Development Goals before 2015. It is worthy to note that Nigeria ranked 70 out of 71 less developed countries as one of the worst places in the world to be a mother and has only 23 per cent of children fully vaccinated (2008 NDHS).

Like a fat determined rat, malaria is taking steady costly bites from all sectors and indeed frustrating health development of sub Saharan African children and draining the life out of our economies; and so we must certainly lay out proven innovative ways to reduce morbidity and mortality rate by increasing level of coverage of programs, providing free/affordable mosquito treated nets, intensifying campaign for pregnant woman to use treated nets and providing facilities to receive diagnostic tests for malaria on all networks all in bid for a healthy wealthy society.

Article: Unen Ameji.

Follow @UnenAmeji on twitter.