The economic and social burden of malaria


Where malaria prospers most, human societies have prospered least. The global distribution of per-capita gross domestic product shows a striking correlation between malaria and poverty, and malaria-endemic countries also have lower rates of economic growth. There are multiple channels by which malaria impedes development, including effects on fertility, population growth, saving and investment, worker productivity, absenteeism, premature mortality and medical costs.

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Figure 1: Global distribution of malaria.
Figure 2: Global distribution of per capita GDP.


  1. 1

    Luria, S. E. 36 Lectures in Biology p. 439 (The MIT Press, Cambridge, 1975).

  2. 2

    Luzzatto, L. Genetics of red cells and susceptibility to malaria. Blood 54, 961–976 (1979).

    CAS  PubMed  Google Scholar 

  3. 3

    Hill, A. V. S. et al. Molecular analysis of the association of HLA-B53 and resistance to severe malaria. Nature 360, 434–439 (1992).

    ADS  CAS  Article  Google Scholar 

  4. 4

    Bremen, J. The ears of the hippopotamus: manifestations, determinants, and estimates of the malaria burden. Am. J. Trop. Med. Hyg. 64(1,2)S, 1–11 (2001).

    Article  Google Scholar 

  5. 5

    World Health Organization. Factsheet No. 94 (World Health Organization, Geneva, 1998).

  6. 6

    Anderson, R. M. & May, R. Infectious Diseases of Humans: Dynamics and Control (Oxford Univ. Press, Tokyo, 1991).

  7. 7

    Colluzzi, M. The clay feet of the malaria giant and its African roots: hypotheses and inferences about origin, spread and control of Plasmodium falciparum. Parassitologia 41, 277–283 (1999).

    Google Scholar 

  8. 8

    Gilles, H. M. & Warrell, D. A. Bruce-Chwatts Essential Malariology (Arnold, Boston, 1993).

  9. 9

    Gallup, J. & Sachs, J. The economic burden of malaria. Am. J. Trop. Med. Hyg. 64(1,2)S, 85–96 (2001).

    Article  Google Scholar 

  10. 10

    Kitron, U. & Spielman, A. Suppression of transmission of malaria through source reduction: antianopheline measures applied in Israel, the United States and Italy. Rev. Infec. Dis. 11, 391–406 (1989).

    CAS  Article  Google Scholar 

  11. 11

    Filmer, D. Fever and its treatment in the more and less poor in sub-Saharan Africa. Development Research Group (The World Bank, Washington DC, 2000).

  12. 12

    Snow, R. W., Craig, M., Deichmann, U. & Marsh, K. Estimating mortality, morbidity and disability due to malaria among Africa's non-pregnant population. Bull. World Health Org. 77, 624–640 (1999).

    CAS  PubMed  Google Scholar 

  13. 13

    Alonso, P. L. et al. The effect of insecticide-treated bed nets on mortality of Gambian children. Lancet 337, 1499–1502 (1991).

    CAS  Article  Google Scholar 

  14. 14

    D'Alessandro, U. et al. Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bednet programme. Lancet 345, 479–483 (1995).

    CAS  Article  Google Scholar 

  15. 15

    Nevill, C. G. et al. Insecticide-treated bednets reduce mortality and severe morbidity from malaria among children on the Kenyan coast. Trop. Med. Int. Health 1, 139–146 (1996).

    CAS  Article  Google Scholar 

  16. 16

    Binka, F. N. Impact of permethrin impregnated bednets on child mortality in Kassena-Nankana district, Ghana: a randomized controlled trial. Trop. Med. Int. Health 1, 147–154 (1996).

    CAS  Article  Google Scholar 

  17. 17

    Yamada, T. Causal relationships between infant mortality and fertility in developed and less developed countries. South. Econ. J. 52, 364–371 (1985).

    Article  Google Scholar 

  18. 18

    Galloway, P. R., Lee, R. D. & Hammel, E. A. in From Death to Birth: Mortality Decline and Reproductive Change (eds Montgomery, M. R. & Cohen, B.) 182–226 (National Academy Press, Washington DC, 1998).

    Google Scholar 

  19. 19

    Handa, S. The impact of education, income, and mortality on fertility in Jamaica. World Dev. 28, 173–186 (2000).

    Article  Google Scholar 

  20. 20

    Rosensweig, M. & Schultz, T. P. Consumer demand and household production: the relationship between fertility and child mortality. Am. Econ. Rev. 73, 38–43 (1983).

    Google Scholar 

  21. 21

    Reher, D. Wasted investments: some economic implications of childhood mortality patterns. Popul. Stud. 49, 519–536 (1995).

    Article  Google Scholar 

  22. 22

    Bloom, D. E., Canning, D. & Malaney, P. N. Demographic change and economic growth in Asia. Popul. Dev. Rev. 26 (Suppl.), 257–290 (2000).

    Google Scholar 

  23. 23

    Leighton, C. & Foster, R. Economic impacts of malaria in Kenya and Nigeria. Major Applied Research Paper no 6, HFS project (Abt Associates, Bethesda, 1993).

  24. 24

    Brooker, S. et al. Situation analysis of malaria in school-aged children in Kenya: what can be done? Parasitol. Today 16, 183–186 (2000).

    CAS  Article  Google Scholar 

  25. 25

    Holding, P. A. & Snow, R. W. Impact of Plasmodium falciparum malaria on performance and learning: review of the evidence. Am. J. Trop. Med. Hyg. 64(1,2)S, 68–75 (2001).

    Article  Google Scholar 

  26. 26

    Rowland, M. G., Cole, T. J. & Whitehead, R. G. A quantitative study into the role of infection in determining nutritional status in Gambian village children. Br. J. Nutr. 37, 441–450 (1977).

    CAS  Article  Google Scholar 

  27. 27

    Shiff, C. et al. Changes in weight gain and anaemia attributable to malaria in Tanzanian children living under holoendemic conditions. Trans. R. Soc. Trop. Med. Hyg. 90, 262–265 (1996).

    CAS  Article  Google Scholar 

  28. 28

    Lozoff, B. Nutrition and behaviour. Am. Psychiatry 44, 231–236 (1989).

    CAS  Google Scholar 

  29. 29

    McKay, H., Sinisterra, L., McKay, A., Gomez, H. & Lloreda, P. Improving cognitive ability in chronically deprived children. Science 200, 270–278 (1978).

    ADS  CAS  Article  Google Scholar 

  30. 30

    Grantham-McGregor, S. M, Powell, C. A., Walker, S. P. & Himes, J. H. Nutritional supplementation, psychosocial stimulation, and mental development of stunted children: the Jamaican study. Lancet 338, 1–5 (1991).

    CAS  Article  Google Scholar 

  31. 31

    Al Serouri, A. W., Grantham-McGregor, S. M., Greenwood, B. & Costello, A. Impact of asymptomatic malaria parasitaemia on cognitive function and school achievement of schoolchildren in the Yemen Republic. Parasitology 121, 337–345 (2000).

    Article  Google Scholar 

  32. 32

    McCormick, M. C., Brooks-Gunn, J., Workman-Daniels, K., Turner, J. & Peckmah, G. J., The health and development status of very low-birth-weight children at school-age. J. Am. Med. Assoc. 267, 2204–2208 (1992).

    CAS  Article  Google Scholar 

  33. 33

    Taylor, H. G. in Early Brain Damage: Research Orientations and Clinical Observation (eds Almli, C. & Fingers, S.) 325–345 (Academic, New York, 1984).

    Google Scholar 

  34. 34

    Murphy, S. & Bremen, J. Gaps in the childhood malaria burden in Africa: cerebral malaria, neurological sequelae, anemia, respiratory distress, hypoglycemia, and complications of pregnancy. Am. J. Trop. Med. Hyg. 64(1,2)S, 57–67 (2001).

    Article  Google Scholar 

  35. 35

    Greenwood, B. et al. Mortality and morbidity from malaria among children in a rural area of The Gambia, West Africa. Trans. R. Soc. Trop. Med. Hyg. 81, 478–486 (1987).

    CAS  Article  Google Scholar 

  36. 36

    Brewster, D. R., Kwiatkowski, D. & White, N. J. Neurological sequelae of cerebral malaria in children. Lancet 336, 1039–1043 (1990).

    CAS  Article  Google Scholar 

  37. 37

    Holding, P. A., Stevenson, J., Pershu, N. & Marsh, K. Cognitive sequelae of malaria with impaired consciousness. Trans. R. Soc. Trop. Med. Hyg. 93, 529–534 (1999).

    CAS  Article  Google Scholar 

  38. 38

    Kere, N. K., Keni, J., Kere, J. F., Bobogare, A. & Webber, R. H. The economic impact of plasmodium falciparum malaria on education investment: a Pacific Island case study. Southeast Asian J. Trop. Med. Public Health 24, 659–663 (1993).

    CAS  PubMed  Google Scholar 

  39. 39

    Nur, E. The impact of malaria on labour use and efficiency in the Sudan. Soc. Sci. Med. 37, 1115–1119 (1993).

    CAS  Article  Google Scholar 

  40. 40

    Sawyer, D. Economic and social consequences of malaria in new colonization projects in Brazil. Soc. Sci. Med. 37, 1131–1136 (1993).

    CAS  Article  Google Scholar 

  41. 41

    Spielman, A. & DiAntonio, M. Mosquito p. 247 (Hyperion, New York, 2001).

  42. 42

    Choice of evils: as a tropical surge makes a comeback, so, too, does DDT. Wall St. J. 26 July (2001).

  43. 43

    Hedberg, K. et al. Plasmodium falciparum-associated anemia in children at a large urban hospital in Zaire. Am. J. Trop. Med. Hyg. 48, 365–371 (1993).

    CAS  Article  Google Scholar 

  44. 44

    Scholz, B. D., Gross, R., Schultink, W. & Sastroamidjojo, S. Anaemia is associated with reduced productivity of women workers even in less-physically-strenuous tasks. Br. J. Nutr. 77, 47–57 (1997).

    CAS  Article  Google Scholar 

  45. 45

    Basta, S., Soekirman, S., Karyadi, D. & Scrimshaw, N. S. Iron deficiency anemia and the productivity of adult males in Indonesia. Am. J. Clin. Nutr. 32, 916–925 (1979).

    CAS  Article  Google Scholar 

  46. 46

    Spielman, A., Kitron, U. & Pollack, R. Time limitation and the role of research in the worldwide attempt to eradicate malaria. J. Med. Entomol. 30, 6–19 (1993).

    CAS  Article  Google Scholar 

  47. 47

    Goodman, C. A., Coleman P. G. & Mills, A. J. Cost-effectiveness of malaria control in sub-Saharan Africa. Lancet 354, 378–385 (1999).

    CAS  Article  Google Scholar 

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This work was carried out under Program on Malaria, Economics and Human Affairs, directed by A. Spielman at the Center for International Development. This article has benefited greatly from Dr Spielman's support and ongoing tutelage in the scientific and epidemiological aspects of the malaria disease and vector. We are also grateful to E. Weinstein for valuable insights, to J. Gallup for previous collaboration, and to A. Kiszewski for sharing his entomological expertise. Excellent research assistance was provided by E. Gummerson.

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Correspondence to Pia Malaney.

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Sachs, J., Malaney, P. The economic and social burden of malaria. Nature 415, 680–685 (2002).

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