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ㆍDATA  2011.08.02    ㆍHIT  2,170
A Decision Analytic Approach to Evidence‐based Malaria :: Dohyeong Kim, Ph.D

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Presentor:  김도형 (Dohyeong Kim)
Degree: Ph.D. in Environment and Health Planning (University of North Carolina at Chapel Hill)
Email: dkim@nccu.edu
Research Area: Global Health Policy and Planning, Public and Environmental Health, Spatial and Economic Modeling for Policy Analysis

                            A Decision Analytic Approach to Evidence‐based Malaria Control in Africa

                                                                                  The Burden of Malaria
• Malaria causes:
– More than 2 million deaths/year
– 300‐500 million acute illnesses/year
• Children and pregnant women are most vulnerable
• Malaria infection rates have risen dramatically in the past 10 years
• 90% of these are in Sub‐Saharan Africa

                                                          Malaria and Poverty
•Disproportionate effects on the poorest countries of the world
•WHO reports indicate that sub‐Saharan Africa's GDP would be up to 32% greater this year if malaria had been eliminated 35 years ago.

                                                Substantial Costs of Malaria
(1) Direct Cost
* Cost of preventive measures
    Treated bed nets
    Prophylactic drugs
    Vector control programs
* Cost of treatment
    Drug resistance
    Effective drugs more expensive
(2) Indirect Cost
* Productivity loss
    Lost school and work days
    Consumption of healthcare resources
* Reduced national economic growth
    Malaria may decrease GDP growth by 1.3%/year

                                                                  Cost of Preventive Measures
•Nets are effective when used properly, but often improperly used in uneducated HH
•Nets impregnated with insecticides are cost effective, but still unavailable for the poorest households
•Effects from insecticide on health and environment are substantial

                                                                DDT & Malaria: Complex Case
• Tradeoff between environmental health and public health
• Examine unintended consequences
• Consider international dimensions of environmental problems

                                                                Chronic Health Effects of DDT
• Endocrine disruption
•Adverse developmental effects
• Changes in immune response
• Kidney and liver damage

                      Call for Well‐informed Decision Making to Handle Malaria Control Policy
Although a number of strategies are available to control malaria, it is very difficult for decision‐makers in a malaria‐endemic country to determine the best combination of interventions given the constraints within local health care delivery systems due to many challenges:
(1) Mistakes are very costly
(2) Multiple actors at multiple scales
(3) Complex tradeoffs b/w health, social, environmental aspects
(4) Dynamics, interdependencies and uncertainties
(5) Complex Human‐Environment Interactions
Thus, we need a special tool to handle this dilemma.

                                                                      Project Objectives
1. Develop an “effective” and “practical” decision support tool to improve the implementation of malaria control strategies, including both vector control and disease management
2. To create an agenda for policy‐relevant malaria research

                                                        MDAST: A Decision Analysis Tool
• MDAST = Malaria Decision Analysis Support Tool
• Multi‐disciplinary approach: Medicine, Risk analysis, Environmental science, Economics, Entomology, etc.
• Implementation science: Scientific knowledge translated into actual practice within specific settings
• Rapid prototyping: Tool is constructed and modified iteratively in a quick turnaround cycle
• Currently, a prototype model is being developed for 3 countries in east Africa (Tanzania, Uganda, and Kenya)…possibility of applying the tool in West Africa (e.g. Liberia)

                                                        Future Steps for Use of the Tool
• Engage stakeholders through structured interviews: ‐ on available control strategies, their health, social, and environmental consequences
‐ coordination and discussion across different sectors
• Conduct stakeholder workshops for testing, training and refinement of the prototype model….then, fostering a policy dialogue among stakeholders
• Use MDAST for value of information analyses to identify key knowledge gaps and create policy‐relevant research agenda (what data would be beneficial in reducing uncertainty?)

                                          Conclusion: What do we learn from this case study?
• Malaria control requires very complex and multifaced decision making processes
• Careful consideration would be needed on tradeoffs between Imminent burden of malaria and long‐term effect of insecticide
• Decision analytic approach can be a tool to integrate conflicting issues and support informed decisions

Update date : 2011.08.03 17:02
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