Wang'ombe J K, Mwabu G M
Department of Community Health, University of Nairobi, Kenya.
Soc Sci Med. 1993 Nov;37(9):1121-30. doi: 10.1016/0277-9536(93)90251-x.
This paper studies the problem of malaria control in irrigation and non-irrigation areas in Kenya. Empirical results show that in both areas, households' level of awareness of malaria as a health problem, including its cause, was very high. However, attempts to trace the direct effects of malaria upon income or upon agricultural production were not statistically important. This does not imply that malaria has no consequence on household welfare. It is possible that the model equations were mis-specified--aggregate variables (total family size, total family income) and failure to quantify land in the production relationships may have contributed to these results. In addition, poor separation of malaria as a disease, from malaria as an infection, may have underestimated the effect of the disease on production. Thirdly, labour substitution (hiring or within-family substitution) was not measured in this early study, but was taken into account in subsequent research. Finally, labour requirements in the annual crop production schedules and the co-relation between these labour requirements and the pattern of adult morbidity were not longitudinally monitored. Cross-section data would bias the findings, particularly in those areas where the peak transmission season is short, where the crop grown does not require major labour input during this transmission season, and where acquisition of immunity would reduce the clinical impact of malaria upon adult labour. These vulnerabilities in the specification of the model and the data collected, probably affect the results obtained. Our empirical work raises a number of interesting and important questions which should be taken into account in future research.
本文研究了肯尼亚灌溉区和非灌溉区的疟疾控制问题。实证结果表明，在这两个地区，家庭对疟疾作为一个健康问题（包括其病因）的认知水平都很高。然而，追踪疟疾对收入或农业生产的直接影响的尝试在统计上并不显著。这并不意味着疟疾对家庭福利没有影响。有可能模型方程设定有误——总量变量（家庭总人口、家庭总收入）以及在生产关系中未能对土地进行量化，可能导致了这些结果。此外，将疟疾作为一种疾病与作为一种感染区分不清，可能低估了该疾病对生产的影响。第三，在这项早期研究中未测量劳动力替代情况（雇佣或家庭内部替代），但在后续研究中予以了考虑。最后，未对一年生作物生产计划中的劳动力需求以及这些劳动力需求与成人发病模式之间的相关性进行纵向监测。横截面数据会使研究结果产生偏差，尤其是在那些疟疾传播高峰期较短、所种植作物在该传播季节不需要大量劳动力投入且获得免疫力会降低疟疾对成人劳动力的临床影响的地区。模型设定和所收集数据中的这些缺陷，可能影响了所获得的结果。我们的实证研究提出了一些有趣且重要的问题，在未来的研究中应予以考虑。
