ADoctoral Dissertation Research in Economics: Estimating the Costs of an Epidemiological Externality from Malaria Control through Indoor Residual Spraying in Uganda

经济学博士论文研究：估算乌干达通过室内残留喷洒控制疟疾的流行病学外部性成本

• 批准号: 0922392
• 负责人: Randall Kramer
• 金额: $ 1.5万
• 依托单位: Duke University
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=0922392&HistoricalAwards=false
• 关键词: ADoctoral; Dissertation; Research; Economics; Estimating

Indoor residual spraying (IRS) of insecticides on interior surfaces of residential structures is currently one of the most cost-effective means of reducing transmission of mosquito-borne human diseases such as malaria. However, IRS remains a controversial malaria control strategy because of the potential environmental and human health impacts of the insecticides utilized. Traditionally, Dichloro-Diphenyl-Trichloroethane (DDT) has been the preferred insecticide in IRS. The acute and chronic impacts of DDT exposure in humans remain uncertain. The negative environmental impacts from the widespread transport of DDT through ecosystems, while still uncertain, have been more clearly demonstrated, yet the costs of these impacts, when considered against clearly established costs of malaria-induced mortality and morbidity remain difficult to assess. Due to these uncertainties, policymakers must understand the conditions under which IRS is effective at reducing malaria transmission. In particular, a coverage rate of 85% of households is widely thought to be necessary to achieve significant, sustainable transmission reductions using IRS. If there are household-level costs associated with allowing IRS, then one would expect a household?s decision whether to accept IRS in their home to be a reflection of these costs as compared to the perceived benefits of malaria reduction, which are largely determined by the IRS decisions of other households. Thus this type of vector control strategy presents potential for an ?epidemiological externality.? This research will implement discrete choiceexperiments (DCEs) using 600 household surveys in 4 to 6 internally displaced person (IDP) camps in the Ugandan district of Gulu?where the malaria burden is particularly high and IRS has been heavily emphasized in vector control?to elicit preferences regarding the acceptance of alternative IRS programs and thereby (a) improve acceptance rates and (b) evaluate the potential for an epidemiological externality.Intellectual MeritWhile other economic and epidemiological research has produced theoretical models of epidemiological externalities, there is little applied work which quantifies the welfare impact of such a market failure in a specific epidemic or endemic context. The use of DCEs to estimate an econometric model that can be used for counterfactual analysis of such an externality is an important methodological innovation, which is of interest to development, environmental, and health economists.Broader ImpactsCurrently, the U.S. President?s Malaria Initiative has emphasized the importance of IRS as a major strategy for malaria control, and the World Health Organization (WHO) recommends DDT as the most cost-effective insecticide in IRS. Because of their costs and uncertain impacts on human health and the environment, it is important that IRS operations achieve the highest disease reduction possible and reflect the informed preferences of the targeted households. Moreover, understanding the confounding potential of epidemiological externalities can point to cooperative strategies to improve IRS efficacy. Thus, this research will aid policymaking by enabling a more precise targeting of well-designed IRS programs in areas where the most benefitis likely to be achieved.

在住宅建筑物内表面进行杀虫剂室内滞留喷洒是目前减少疟疾等蚊媒人类疾病传播的最具成本效益的手段之一。然而，由于所使用的杀虫剂可能对环境和人类健康产生影响，室内滞留喷洒仍然是一种有争议的疟疾控制战略。传统上，二氯-二苯基-三氯乙烷（DDT）是室内滞留喷洒中首选的杀虫剂。接触滴滴涕对人类的急性和慢性影响仍不确定。滴滴涕通过生态系统广泛传播所产生的负面环境影响虽然仍不确定，但已得到更明确的证明，然而，如果对照疟疾引起的死亡和发病的明确成本来考虑，这些影响的成本仍难以评估。由于这些不确定性，决策者必须了解IRS在何种条件下能够有效减少疟疾传播。特别是，85%的家庭的覆盖率被广泛认为是必要的，以实现显着的，可持续的传输减少使用IRS。如果有家庭层面的成本与允许国税局，那么人们会期望一个家庭？与减少疟疾的预期效益相比，其他家庭决定是否在其家中接受IRS是这些成本的反映，而减少疟疾的预期效益在很大程度上取决于其他家庭的IRS决定。因此，这种类型的矢量控制策略提出了潜在的？流行病学外部性这项研究将实施离散选择实验（DCEs），使用600个家庭调查，在4至6个国内流离失所者（IDP）在乌干达地区古卢营地？在疟疾负担特别重、在病媒控制中高度重视室内滞留喷洒的国家，为了引起关于替代IRS方案的接受的偏好，从而（a）提高接受率和（B）评估流行病学外部性的潜力。智力MeritonalWhile其他经济学和流行病学研究已经产生了流行病学外部性的理论模型，很少有应用工作量化在特定流行病或地方病背景下这种市场失灵的福利影响。使用的DCE估计的计量经济模型，可用于反事实分析这样的外部性是一个重要的方法创新，这是感兴趣的发展，环境和健康的经济学家。世界卫生组织（世卫组织）的疟疾倡议强调室内滞留喷洒作为控制疟疾的一项主要战略的重要性，世界卫生组织（世卫组织）建议将滴滴涕作为室内滞留喷洒中最具成本效益的杀虫剂。由于室内滞留喷雾杀虫剂的成本以及对人类健康和环境的不确定影响，室内滞留喷雾杀虫剂的操作必须尽可能最大限度地减少疾病，并反映目标家庭的知情偏好。此外，了解流行病学外部性的混淆潜力可以指出提高IRS功效的合作战略。因此，这项研究将有助于政策制定，使一个更精确的目标，精心设计的IRS计划的地区，最有可能实现的利益。