CES-CNRS, Université Paris 1, Panthéon-Sorbonne, Centre d'économie de la Sorbonne, Maison des Sciences Economiques, 106-112 Boulevard de l'Hôpital, 75013 Paris, France.
Malar J. 2013 Jun 13;12:200. doi: 10.1186/1475-2875-12-200.
In spite of massive efforts to generalize efficient prevention, such as insecticide-treated mosquito nets (ITN) or long-lasting insecticidal nets (LLINs), malaria remains prevalent in many countries and ITN/LLINs are still only used to a limited extent.
This study proposes a new model for malaria economic analysis by combining economic epidemiology tools with the literature on poverty traps. A theoretical model of rational protective behaviour in response to malaria is designed, which includes endogenous externalities and disease characteristics. Survey data available for Uganda provide empirical support to the theory of prevalence-elastic protection behaviours, once endogeneity issues related to epidemiology and poverty are solved.
Two important conclusions emerge from the model. First, agents increase their protective behaviour when malaria is more prevalent in a society. This is consistent with the literature on "prevalence-elastic behaviour". Second, a 'malaria trap' defined as the result of malaria reinforcing poverty while poverty reduces the ability to deal with malaria can theoretically exist and the conditions of existence of the malaria trap are identified.
These results suggest the possible existence of malaria traps, which provides policy implications. Notably, providing ITN/LLINs at subsidized prices is not sufficient. To be efficient an ITN/LLINs dissemination campaigns should include incentive of the very poor for using ITN/LLINs.
尽管为普及高效预防措施（如经杀虫剂处理的蚊帐或长效驱虫蚊帐）做出了巨大努力，但疟疾在许多国家仍很普遍，而且经杀虫剂处理的蚊帐或长效驱虫蚊帐的使用范围仍然有限。
本研究通过将经济流行病学工具与贫困陷阱文献相结合，提出了一种新的疟疾经济分析模型。设计了一种针对疟疾的理性保护行为的理论模型，其中包括内生外部性和疾病特征。乌干达现有的调查数据为流行弹性保护行为理论提供了实证支持，一旦解决了与流行病学和贫困相关的内生性问题。
该模型得出了两个重要结论。首先，当一个社会中的疟疾更为普遍时，人们会增加他们的保护行为。这与关于“流行弹性行为”的文献一致。其次，理论上可能存在“疟疾陷阱”，即疟疾加剧贫困，而贫困又降低了应对疟疾的能力，并且确定了疟疾陷阱存在的条件。
这些结果表明可能存在疟疾陷阱，这为政策制定提供了启示。值得注意的是，以补贴价格提供经杀虫剂处理的蚊帐或长效驱虫蚊帐是不够的。为了提高效率，经杀虫剂处理的蚊帐或长效驱虫蚊帐的传播活动应该包括激励最贫困人口使用经杀虫剂处理的蚊帐或长效驱虫蚊帐。
