The online version of this article (doi:10.1186/s12916-017-0948-8) contains supplementary material, which is available to authorized users.
Scale-up of malaria interventions over the last decade have yielded a significant reduction in malaria transmission and disease burden in sub-Saharan Africa. We estimated economic gradients in the distribution of these efforts and of their impacts within and across endemic countries.
Using Demographic and Health Surveys we computed equity metrics to characterize the distribution of malaria interventions in 30 endemic countries proxying economic position with an asset-wealth index. Gradients were summarized in a concentration index, tabulated against level of coverage, and compared among interventions, across countries, and against respective trends over the period 2005–2015.
There remain broad differences in coverage of malaria interventions and their distribution by wealth within and across countries. In most, economic gradients are lacking or favor the poorest for vector control; malaria services delivered through the formal healthcare sector are much less equitable. Scale-up of interventions in many countries improved access across the wealth continuum; in some, these efforts consistently prioritized the poorest. Expansions in control programs generally narrowed coverage gaps between economic strata; gradients persist in countries where growth was slower in the poorest quintile or where baseline inequality was large. Despite progress, malaria is consistently concentrated in the poorest, with the degree of inequality in burden far surpassing that expected given gradients in the distribution of interventions.
Economic gradients in the distribution of interventions persist over time, limiting progress toward equity in malaria control. We found that, in countries with large baseline inequality in the distribution of interventions, even a small bias in expansion favoring the least poor yielded large gradients in intervention coverage while pro-poor growth failed to close the gap between the poorest and least poor. We demonstrated that dimensions of disadvantage compound for the poor; a lack of economic gradients in the distribution of malaria services does not translate to equity in coverage nor can it be interpreted to imply equity in distribution of risk or disease burden. Our analysis testifies to the progress made by countries in narrowing economic gradients in malaria interventions and highlights the scope for continued monitoring of programs with respect to equity.
Additional file 1: Tables SA1. and SA2 that list by country: country name, ISO3 code, mean population weighted PfPR 2-10 , and corresponding DHS/MIS survey used in 2015 tabulations and 2005–2015 year trend analyses. (DOCX 37 kb)12916_2017_948_MOESM1_ESM.docx
Additional file 2: Tables detailing country estimates corresponding to level and degree of inequality for each of the malaria intervention coverage indicators including ACTs (Tables SA3-SA9). (DOCX 93 kb)12916_2017_948_MOESM2_ESM.docx
Additional file 3: Plots of 2015* level and degree of inequality for each of the malaria intervention coverage indicators including ACTs (Figure SA1-SA2). (DOCX 84 kb)12916_2017_948_MOESM3_ESM.docx
Additional file 4: Plots of excess change and change in each of the malaria intervention coverage indicators from 2005 to 2015* (Additional file 2: Figure SA2). (DOCX 65 kb)
Additional file 5: Table SA10. 2015* malaria parasite prevalence estimates according to rapid diagnostic tests based on country DHS/MIS surveys. (DOC 45 kb)12916_2017_948_MOESM5_ESM.doc
World Health Organization. World Malaria Report 2016. Geneva: WHO; 2016. CrossRef
World Health Organization. World Malaria Report 2008. Geneva: WHO; 2008. CrossRef
O'Connell KA, Gatakaa H, Poyer S, Njogu J, Evance I, Munroe E, Solomon T, Goodman C, Hanson K, Zinsou C, et al. Got ACTs? Availability, price, market share and provider knowledge of anti-malarial medicines in public and private sector outlets in six malaria-endemic countries. Malar J. 2011;10:326. CrossRefPubMedPubMedCentral
Secretary-General announces ‘Roll Back Malaria Partnership’ on World Malaria Day. New York: United Nations Secretary-General (SG/SM/11531); 2008.
Roll Back Malaria. Global Malaria Action Plan: For a Free Malaria World. Geneva: RBM Partnership; 2008.
Roll Back Malaria. Refined/Updated GMAP Objectives, Targets, Milestones and Priorities Beyond 2011. Geneva: RBM Partnership; 2011.
World Health Organization. Guidelines for the treatment of malaria. Geneva: WHO; 2006.
The Global Fund. Overview. https://www.theglobalfund.org/en/overview/. Accessed 11 Oct 2017.
Gelband H, Seiter A. A global subsidy for antimalarial drugs. Am J Trop Med Hyg. 2007;77:219–21. PubMed
Young M, Wolfheim C, Marsh DR, Hammamy D. World Health Organization/United Nations Children's Fund joint statement on integrated community case management: an equity-focused strategy to improve access to essential treatment services for children. Am J Trop Med Hyg. 2012;87:6–10. CrossRefPubMedPubMedCentral
Bonner K, Mwita A, McElroy P, Omari S, Mzava A, Lengeler C, Kaspar N, Nathan R, Ngegba J, Mtung'e R, Brown N. Design, implementation and evaluation of a national campaign to distribute nine million free LLINs to children under five years of age in Tanzania. Malar J. 2011;10:73. CrossRefPubMedPubMedCentral
Ntuku HM, Ruckstuhl L, Julo-Reminiac JE, Umesumbu SE, Bokota A, Tshefu AK, Lengeler C. Long-lasting insecticidal net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasai Occidental Province, Democratic Republic of Congo. Malar J. 2017;16:22. CrossRefPubMedPubMedCentral
Barat L, Palmer N, Basu S, Worral E, Hanson K, Mills A. Do malaria control interventions reach the poor? A view through the equity lens. Am J Trop Med Hyg. 2004;71:174–8. PubMed
Hill J, Hoyt J, van Eijk AM, D'Mello-Guyett L, ter Kuile FO, Steketee R, Smith H, Webster J. Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med. 2013;10(7):e1001488. CrossRefPubMedPubMedCentral
Victora CG, Barros AJ, Axelson H, Bhutta ZA, Chopra M, Franca GV, Kerber K, Kirkwood BR, Newby H, Ronsmans C, Boerma JT. How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys. Lancet. 2012;380:1149–56. CrossRefPubMed
Taylor C, Florey L, Yazoume Y. Increasing equity of insecticide-treated net ownership in sub-Saharan Africa from 2003 to 2014. In: DHS Analytic Studies, vol. 52. Rockville: ICF International; 2015.
World Health Organization. Handbook on health inequality monitoring: with a special focus on low- and middle-income countries. Geneva: WHO; 2013.
Burgert CR, Bradley SEK, Eckert E, Arnold F. Improving estimates of insecticide-treated mosquito net coverage from household surveys: using geographic coordinates to account for endemicity and seasonality. In: DHS Analytical Studies, vol. 32. Calverton: ICF International; 2012.
Demographic and Health Surveys. http://www.measuredhs.com/. Accessed 11 Oct 2017.
Florey L. Measures of malaria parasitemia prevalence in national surveys: agreement between rapid diagnostic testing and microscopy. In: DHS Analytical Studies No 43. Rockville: ICF International; 2014.
Malaria Atlas Project. http://www.map.ox.ac.uk/map/. Accessed 11 Oct 2017.
Bennett A, Bisanzio D, Yukich JO, Mappin B, Fergus CA, Lynch M, Cibulskis RE, Bhatt S, Weiss DJ, Cameron E, et al. Population coverage of artemisinin-based combination treatment in children younger than 5 years with fever and Plasmodium falciparum infection in Africa, 2003-2015: a modelling study using data from national surveys. Lancet Global Health. 2017;5:E418–27. CrossRefPubMed
Population Estimates and Projections, World Bank Group. https://data.worldbank.org/data-catalog/population-projection-tables. Accessed 15 Mar 2017.
World Health Organization. Guidelines for treatment of malaria. 2nd ed. Geneva: WHO; 2010.
Rutstein S, Johnson K. The DHS Wealth Index. In: DHS Comparative Reports, vol. 6. Calverton: ORC Macro; 2004.
Tusting LS, Rek JC, Arinaitwe E, Staedke SG, Kamya MR, Bottomley C, Johnson D, Lines J, Dorsey G, Lindsay SW. Measuring socioeconomic inequalities in relation to malaria risk: a comparison of metrics in rural Uganda. Am J Trop Med Hygiene. 2016;94:650–8. CrossRef
Mwageni E, Masanja H, Juma Z, Momburi D, Mkilindi Y, Mbuya C, Kasale H, Reid G, de Savigny D. Socio-economic status and health inequalities in rural Tanzania: Evidence from the Rufiji demographic surveillance system. In: Network I, editor. Measuring Health Equity in Small Areas Findings from Demographic Surveillance Systems. Aldershot: Ashgate Publishing Ltd; 2005. p. 19–32.
O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data : a guide to techniques and their implementation. Washington, DC: World Bank Group; 2007. CrossRef
World Health Organization. State of inequality: reproductive, maternal, newborn, and child health. Geneva: WHO; 2015.
Roll Back Malaria. Household Survey Indicators for Malaria Control. 2013. http://www.malariasurveys.org/documents/Household%20Survey%20Indicators%20for%20Malaria%20Control.pdf.
The DHS Program. Publications. http://www.dhsprogram.com/publications/index.cfm. Accessed 11 Oct 2017.
StataCorp. Stata Statistical Software: Release 14. College Station: StataCorp LP; 2015.
Wagstaff A, Bredenkamp C, Buisman LR. Progress on global health goals: are the poor being left behind? World Bank Res Obs. 2014;29:137–62. CrossRef
Suzuki E, Sharan M, Bos E. Poverty and health monitoring report. In: Lutalo M, editor. Health, Nutrition and Population (HNP) Discussion Paper. Washington, DC: The International Bank for Reconstruction and Development/The World Bank; 2012.
World Health Organization. Malaria Vaccine: WHO Position Paper - January 2016. In Weekly Epidemiological Record. pp. 33-52. http://www.who.int/wer/2016/wer9104/en/. Accessed 11 Oct 2017.
Hosseinpoor AR, Bergen N, Schlotheuber A, Gacic-Dobo M, Hansen PM, Senouci K, Boerma T, Barros AJD. State of inequality in diphtheria-tetanus-pertussis immunisation coverage in low-income and middle-income countries: a multicountry study of household health surveys. Lancet Glob Health. 2016;4:e617–26. CrossRefPubMedPubMedCentral
Tugwell P, de Savigny D, Hawker G, Robinson V. Applying clinical epidemiological methods to health equity: the equity effectiveness loop. Br Med J. 2006;332:358–61. CrossRef
Keinberger S, Hagenlocher M. Spatial-explicit modeling of social vulnerability to malaria in East Africa. Int J Health Geogr. 2014;13:29. CrossRef
Tatem AJ, Gething PW, Pezzulo C, Weiss DJ, Bhatt S. Final Report: Development of High-Resolution Gridded Poverty Surfaces. In: Development of High-Resolution Gridded Poverty Surfaces. 2014.
Steele JE, Sundsoy PR, Pezzulo C, Alegana VA, Bird TJ, Blumenstock J, Bjelland J, Engo-Monsen K, de Montjoye YA, Iqbal AM, et al. Mapping poverty using mobile phone and satellite data. J R Soc Interface. 2017;14(127). doi: 10.1098/rsif.2016.0690.
Bosco C, Alegana V, Bird T, Pezzulo C, Bengtsson L, Sorichetta A, Steele J, Hornby G, Ruktanonchai C, Ruktanonchai N, et al. Exploring the high-resolution mapping of gender-disaggregated development indicators. J R Soc Interface. 2017;14(129). doi: 10.1098/rsif.2016.0825.
World Health Organization. Global Technical Strategy for Malaria 2016–2030. Geneva: WHO; 2015.
World Health Organization on behalf of the Roll Back Malaria Partnership Secretariat 2015. Action and Investment to Defeat Malaria 2016–2030. For a Malaria-Free World. Geneva: WHO; 2015
Sustainable Development Goals: 17 Goals to Transform our World. http://www.un.org/sustainabledevelopment/sustainable-development-goals/. Accessed 11 Oct 2017.
- State of inequality in malaria intervention coverage in sub-Saharan African countries
Thomas A. Smith
Don de Savigny
Melissa A. Penny
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