Chima Reginald Ikechukwu, Goodman Catherine A, Mills Anne
Department of Economics, University of Nigeria, Nsukka, Enugu State, Nigeria.
Health Policy. 2003 Jan;63(1):17-36. doi: 10.1016/s0168-8510(02)00036-2.
Information on the economic burden of malaria in Africa is needed to target interventions efficiently and equitably, and to justify investment in research and control. A standard method of estimation has been to sum the direct costs of expenditure on prevention and treatment, and the indirect costs of productive labour time lost. This paper discusses the many problems in using such data to reflect the burden to society or the potential benefits from control. Studies have generally focussed on febrile illness, overestimating the burden of uncomplicated malaria, but underestimating the costs of severe illness, other debilitating manifestations, and mortality. Many use weak data to calculate indirect costs, which fail to account for seasonal variations, the difference between the average and marginal product of labour, and the ways households and firms 'cope' in response to illness episodes. Perhaps most importantly, the costs of coping mechanisms in response to the risk of disease are excluded, although they may significantly affect productive strategies and economic growth. Future work should be rooted in a sound understanding of the health burden of malaria and the organisation of economic activities, and address the impact on the productive environment, and epidemiological and socio-economic geographical variation.
要有效且公平地开展疟疾防治干预措施，并为疟疾研究与防控投资提供合理依据，就需要了解非洲疟疾的经济负担情况。一种标准的估算方法是将预防和治疗支出的直接成本与生产性劳动时间损失的间接成本相加。本文讨论了使用此类数据来反映社会负担或防控潜在效益时存在的诸多问题。研究通常聚焦于发热性疾病，高估了单纯性疟疾的负担，但低估了重症、其他使人虚弱的症状及死亡的成本。许多研究使用的数据薄弱，难以计算间接成本，这些数据未考虑季节变化、劳动平均产量与边际产量的差异，以及家庭和企业应对疾病发作的“应对方式”。或许最重要的是，应对疾病风险的应对机制成本被排除在外，尽管它们可能会对生产策略和经济增长产生重大影响。未来的工作应以对疟疾健康负担和经济活动组织的深入理解为基础，解决对生产环境、流行病学及社会经济地理差异的影响。
