Malaria and pneumonia effects on rice, vanilla production and rural household income in Madagascar: case of the Sava region

In Madagascar, malaria remains the leading cause of consultation and deaths at hospital at all ages and pneumonia is one of the main causes of the under-five mortality and account for 45% of children hospitalizations. The number of these cases and deaths has not decreased during the last ten years. This paper aims to determine the effects of malaria and pneumonia cases on rice and vanilla production and income. We used data from a cross-sectional survey conducted in 2016  by the authors on 975 rural households and 3,586 individuals of the SAVA region in the northeast of Madagascar. After checking the presence of endogeneity, ordinary least-square method was used instead of two-stage least squares. Our results showed that malaria has no effect on production, and therefore does not affect income. Pneumonia had an effect on production of rice and vanilla. Moreover, the cost of malaria and pneumonia healthcare burdened by households affect their consumption by reducing expenditure on housing. There are many campaigns for the fight against malaria in Madagascar, but pneumonia prevention measures are very rare. Therefore, pneumonia should be considered in the same way as malaria due to its effects on production and investment to fight against these two diseases must be strengthened in order to decrease the costs for the households

Effets économiques du paludisme et de la pneumonie à Madagascar

Malaria and pneumonia remain a public health problem in low-income countries, including Madagascar. However, while malaria has received more attention and its control programs have been strengthened since the creation of the Global Fund in 2002, pneumonia is often neglected. Face on the encouraging results of malaria community case management, UNICEF wants to integrate pneumonia management at community level. To support this advocacy, the impact and the cost-effectiveness of this strategy must be known to verify that it is effective and efficient. This is the purpose of Chapter 4 of this thesis which studies the pilot experiment conducted by Unicef in the district of Antalaha. It is shown that this program has had a significant impact on the management of malaria and pneumonia. However, the quality of this care is questioned. This situation indicates that, before scaling up, this program should be revised to improve it. Besides the loss of well-being, malaria and pneumonia have a financial and economic cost. Therefore, the economic effects of the two diseases are shown in the chapters 2 and 3 concerning the case of Madagascar. Previously, the theoretical under-base of the link between health and economic development is presented in the first chapter.Le paludisme et la pneumonie constituent encore des problèmes de santé publique dans les pays à faible revenu, dont Madagascar. Toutefois, si le paludisme a reçu plus d’attention et vu ses programmes de lutte renforcés depuis la création du Fonds mondial en 2002, la pneumonie quant à elle est souvent négligée. Cependant, depuis peu, l’Unicef, s’appuyant sur les résultats encourageants obtenus au niveau communautaire dans la lutte contre le paludisme, pousse à l’intégration du dépistage et de la prise en charge de la pneumonie au niveau communautaire. Pour appuyer ce plaidoyer, des études d’impact et de type coût-efficacité sont nécessaires pour vérifier que cette stratégie est bien efficace et efficiente. C’est l’objet du chapitre 4 de cette thèse qui étudie l’expérience pilote menée par l’Unicef dans le district d’Antalaha. Nous montrons que ce programme a eu un impact notable sur la prise en charge du paludisme et de la pneumonie. Toutefois, la qualité de cette prise en charge est encore remise en question. Cela indique que, avant de décider d’une mise à l’échelle, ce programme mérite d’être révisé pour l’améliorer. Outre la perte de bien-être, le paludisme et la pneumonie ont un coût financier d’abord, économique, ensuite. Un des arguments de plaidoyer est alors de montrer, s’il y en a, les effets économiques des deux maladies. C’est l’objet des chapitres 2 et 3 avec une application à Madagascar. Auparavant, le sous-bassement théorique du lien entre santé et revenu ou développement économique est présenté dans le premier chapitre

Effets économiques du paludisme et de la pneumonie à Madagascar

Malaria and pneumonia remain a public health problem in low-income countries, including Madagascar. However, while malaria has received more attention and its control programs have been strengthened since the creation of the Global Fund in 2002, pneumonia is often neglected. Face on the encouraging results of malaria community case management, UNICEF wants to integrate pneumonia management at community level. To support this advocacy, the impact and the cost-effectiveness of this strategy must be known to verify that it is effective and efficient. This is the purpose of Chapter 4 of this thesis which studies the pilot experiment conducted by Unicef in the district of Antalaha. It is shown that this program has had a significant impact on the management of malaria and pneumonia. However, the quality of this care is questioned. This situation indicates that, before scaling up, this program should be revised to improve it. Besides the loss of well-being, malaria and pneumonia have a financial and economic cost. Therefore, the economic effects of the two diseases are shown in the chapters 2 and 3 concerning the case of Madagascar. Previously, the theoretical under-base of the link between health and economic development is presented in the first chapter.Le paludisme et la pneumonie constituent encore des problèmes de santé publique dans les pays à faible revenu, dont Madagascar. Toutefois, si le paludisme a reçu plus d’attention et vu ses programmes de lutte renforcés depuis la création du Fonds mondial en 2002, la pneumonie quant à elle est souvent négligée. Cependant, depuis peu, l’Unicef, s’appuyant sur les résultats encourageants obtenus au niveau communautaire dans la lutte contre le paludisme, pousse à l’intégration du dépistage et de la prise en charge de la pneumonie au niveau communautaire. Pour appuyer ce plaidoyer, des études d’impact et de type coût-efficacité sont nécessaires pour vérifier que cette stratégie est bien efficace et efficiente. C’est l’objet du chapitre 4 de cette thèse qui étudie l’expérience pilote menée par l’Unicef dans le district d’Antalaha. Nous montrons que ce programme a eu un impact notable sur la prise en charge du paludisme et de la pneumonie. Toutefois, la qualité de cette prise en charge est encore remise en question. Cela indique que, avant de décider d’une mise à l’échelle, ce programme mérite d’être révisé pour l’améliorer. Outre la perte de bien-être, le paludisme et la pneumonie ont un coût financier d’abord, économique, ensuite. Un des arguments de plaidoyer est alors de montrer, s’il y en a, les effets économiques des deux maladies. C’est l’objet des chapitres 2 et 3 avec une application à Madagascar. Auparavant, le sous-bassement théorique du lien entre santé et revenu ou développement économique est présenté dans le premier chapitre

Malaria and pneumonia eects on rice, vanilla production and rural household income in Madagascar: case of the Sava region

International audienc

DETERMINANTS DE L’ACCES AUX SOINS DES MERES ET ENFANTS A MADAGASCAR : CAS DU DISTRICT DE MANANDRIANA

Comme d’autres pays membres des Nations Unies, Madagascar s’est engagé dans l’atteinte des Objectifs du Développement Durable d’ici 2030. Le pays vise ainsi entre autres à réduire la mortalité maternelle et infantile. En effet, l’Etat malagasy à travers le Ministère de la Santé Publique, a introduit la santé des mères et enfants dans ses cibles, et vise à « faire passer le taux national de mortalité maternelle au-dessous de 70 pour 100 000 naissances vivante » (cible 3.1) ainsi que “ éliminer les décès évitables des nouveaux nés et d’enfant de moins de 5ans ” (cible 3.2) d’ici 2030. L’objectif de cet article est ainsi de déterminer les facteurs qui bloquent le recours aux soins au niveau des Centres de Santé de Base (CSB) du district de Manandriana, Région Amoron’i Mania. Une enquête a été menée au sein même du district. Le modèle logit multinomial a été utilisé pour analyser la relation entre le recours aux soins et les variables indépendantes (l’âge de la mère, son état matrimonial et la taille de ménage, l’éducation, le revenu et la distance) afin de déterminer les barrières qui entravent le recours aux CSB. Les résultats ont montré que la distance (p-value : 0,00***) et le revenu (p-value : 0,06*) constituent les principaux déterminants du choix de non recours au CSB favorisant l’automédication ou le recours aux tradipraticiens. Ainsi, il faut résoudre les barrières géographiques et financières pour favoriser le recours aux CSB

Malaria and pneumonia effects on rice, vanilla production and rural household income in Madagascar: case of the Sava region

In Madagascar, malaria remains the leading cause of consultation and deaths at hospital at all ages and pneumonia is one of the main causes of the under-five mortality and account for 45% of children hospitalizations. The number of these cases and deaths has not decreased during the last ten years. This paper aims to determine the effects of malaria and pneumonia cases on rice and vanilla production and income. We used data from a cross-sectional survey conducted in 2016  by the authors on 975 rural households and 3,586 individuals of the SAVA region in the northeast of Madagascar. After checking the presence of endogeneity, ordinary least-square method was used instead of two-stage least squares. Our results showed that malaria has no effect on production, and therefore does not affect income. Pneumonia had an effect on production of rice and vanilla. Moreover, the cost of malaria and pneumonia healthcare burdened by households affect their consumption by reducing expenditure on housing. There are many campaigns for the fight against malaria in Madagascar, but pneumonia prevention measures are very rare. Therefore, pneumonia should be considered in the same way as malaria due to its effects on production and investment to fight against these two diseases must be strengthened in order to decrease the costs for the households

Do public health expenditures affect maternal and child health in Madagascar?

International audienceBackground: Previous studies have argued that the relationship between health expenditures and health outcomes is more significant among the poor than the non-poor. However, public spending alone does not improve health status. Quality of governance is considered not only as an important determinant of health outcomes but also of the efficiency of public expenditure on health. In low-income countries, barriers to quality service provision can be observed, which may explain the effects of health expenditures. Therefore, this paper aims to identify the relationship between health expenditures and maternal and child mortality in Madagascar and the potential bottlenecks in the flow of funds for maternal and child health. Methods: Using panel data, fixed and random effect models for the 22 regions of Madagascar over the period 2010 to 2017 were used. Then bottlenecks related to the flow of funds for maternal and child health were identified. Results: The results reveal that, on the one hand, funding for maternal health, mainly constituted by equipment endowments for health facilities, significantly contributes to the improvement of maternal health (-0.35; p-value = 0.00). On the other hand, child health financing, often realized through transfers of funds to the health system, does not affect children’s health (0.22; p-value = 0.88). The bottleneck analysis illustrates that the transferred funds can suffer from delay or misappropriation and only few parts reach beneficiaries. Conclusions: Equipment endowments contributed more to health improvement and would be more effective than monetary financing

Impact and Efficiency of the Integration of Diagnosis and Treatment of Pneumonia in Malaria Community Case Management in Madagascar

In Madagascar, in February 2014, the Ministry of Health and UNICEF implemented a program integrating the diagnosis and treatment of pneumonia into malaria community case management. The objectives of this program were to improve the management of cases of malaria and pneumonia by community health workers to alleviate the problem of accessibility to care and to reduce the number of severe cases treated at health facilities. This paper aims to assess the effectiveness and the efficiency of this. Two districts were taken into account: Andapa received only basic activities ensuring the functionality of the community sites (control district) and Antalaha where all activities related to the program were implemented (treated district). To assess the impact of the program, we use the difference in difference methodology and we compare the period before the implementation of the program in January 2014 and the period when the program is implemented in February 2016. Then cost-effectiveness analysis was made. In Antalaha, although the program has no significant impact on pneumonia, the situation is better than that of Andapa, as in the case of malaria management, the difference is significant between the two districts. The cost-effectiveness analysis also demonstrated that the cost per case of additional malaria and pneumonia treated by CHWs is 2.52 USD (2.44-3.50). However, skills of CHWs should be strengthened especially concerning pneumonia cases management

Impact et efficience de l’intégration du diagnostic et du traitement de la pneumonie dans la prise en charge communautaire du paludisme à Madagascar

International audienceIn 2014, a program integrating the diagnosis and treatment of pneumonia into malaria community case management was implemented in Madagascar. Its objective was to improve the accessibility to care by the use of community health workers (CHWs). This paper aimed to assess the effectiveness and the efficiency of this program. Two districts were taken into account: Andapa, which received only basic activities (control), and Antalaha, where all activities were implemented (treated). Impact analysis based on the difference in difference methodology and cost-effectiveness analysis were made. The program had significant impact on pneumonia and malaria case management. The cost-effectiveness analysis demonstrated that the cost per case of additional malaria and pneumonia treated by CHWs was between 8.66 and 9.68 USD.En 2014, un programme d’intégration de la prise en charge de la pneumonie dans celle du paludisme au niveau communautaire a été mis en place à Madagascar. Cela visait à améliorer l’accessibilité aux soins grâce au recours aux agents communautaires (AC). Cet article évalue l’efficacité et l’efficience de ce programme. Deux districts ont été pris en compte, à savoir Andapa, district de contrôle qui n’a reçu que des activités de base, et Antalaha, district traité où la totalité des activités a été mise en œuvre. Une analyse d’impact basée sur la méthode de la double différence et une analyse coût-efficacité ont été effectuées. Le programme a eu un impact significatif sur la prise en charge de ces deux maladies par les AC. L’analyse coût-efficacité a démontré que le coût par cas supplémentaire traité par ces derniers est entre 8,66 et 9,68 USD