By Shunmay Yeung, Professor of Infectious Disease and Global Health
Economic and social research helps inform evidence-based decision making and allows research methods to be adapted, based on epidemiological settings. This approach is utilised by researchers at the Malaria Centre to reduce both the burden and rise in antimalarial and insecticide resistance around the world. The evidence-base is also useful from a political and health care context, whereby researchers have recognised the role of the private sector in the strive towards malaria elimination. Finally, looking through economic and social lens has birthed novel technologies (PBO nets) and novel approaches, discussed further in this section.
To help address questions on how best to achieve malaria elimination in low transmission areas in Africa and in Southeast Asia, different strategies are being deployed. For example, Malaria Centre researchers are conducting economic evaluations, alongside trials of targeted community-based antimalarial drug administration, in The Gambia. Further, on the Cambodia-Thai border, sensitive diagnostic tests are being used for active case detection whilst concurrently, an ethnographic study is implemented to try to get a better understanding of the hard-to-reach at-risk population – adults who go to work deep in the forest. An ethnographic approach is also being used in Uganda, to explore the ‘how’ and ‘why’ of antimalarial and other antimicrobial usage in everyday life.
With a focus on vector control, researchers at the Centre have carried out economic evaluations of targeted reactive indoor residual spraying (IRS), compared to generalised IRS in South Africa. Further research is underway looking at the addition of IRS to case management in refugee settlements in Pakistan and as part of a private sector malaria prevention programme in Ghana. Likewise, economic evaluation of PBO long-lasting insecticide treated nets in Tanzania has been crucial to influencing WHO policy. The acceptability and feasibility of spatial repellents in Cambodia is also covered in this section.
Finally, in terms of case management, there is increasing recognition of the private for-profit sector as a source of antimalarial treatment. Centre members work on a range of health systems and economic studies, including exploring the role they play in Uganda and modelling cost-effectiveness of introducing rapid diagnostic tests (RDTs) in the private sector in Sub-Saharan Africa. It is crucial that economic evaluation informs malaria research to ensure the market is functioning optimally, thus remaining as affordable as possible for the affected population and local governments. This will in turn prevent exploitative practices from developing during administering of treatment and practical supplies, such as nets and insecticide.