Understanding the malaria-poverty vicious circle

了解疟疾与贫困的恶性循环

• 批准号: 7708798
• 负责人: MARCIA C. CASTRO
• 金额: $ 16.35万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-23 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7708798
• 关键词: Adopted; African; Agriculture; Angola; Back; Behavioral; Biological; Communities; Country; Data; Databases; Demographic and Health Surveys; Disease; Economics; Equation; Ethnic Origin; Etiology; Evaluation; Fever; Future; Gender; Goals; Health; Household; Housing; Incidence; Income; Individual; Intervention; Investigation; Investments; Least-Squares Analysis; Link; Malaria; Measurement; Measures; Methods; Microscopy; Modeling; Occupations; Ownership; Parasitemia; Parasites; Phase; Policies; Policy Maker; Poverty; Precipitation; Pregnancy; Proxy; Research; Research Priority; Review Literature; Risk; Running; Rural; Rwanda; Seasons; Side; Socioeconomic Status; Staging; Surveys; System; Tanzania; Testing; Variant; abstracting; base; coping; design; disorder prevention; economic impact; falls; high risk; indexing; instrument; low socioeconomic status; multidisciplinary; poverty alleviation; public health relevance; remote sensing; response; social

DESCRIPTION (provided by applicant): Understanding the malaria-poverty vicious circle 6. Project Summary/Abstract The long-term goals of this research are (a) to develop a conceptual framework for understanding the potential bi-directional malaria-poverty causality; (b) to empirically test the proposed conceptual framework; (c) to provide evidence regarding the magnitude of the dual relationship between malaria and socioeconomic status (SES); (d) to design new survey instruments that facilitate the measurement of mechanisms included in the proposed conceptual framework but not yet available in standard surveys; and (e) to evaluate the economic impacts of successful malaria control interventions. As a first step toward these long-term goals, the objectives of this R21 application are to develop analytical and empirical assessments of the bi-directional malaria- poverty causality. We will propose a conceptual framework based on literature review of factors that impact the links between malaria and poverty, and we will add a layer of complexity by proposing possible variations of these links at multiple spatial scales. The framework builds upon a systemic view of malaria; it will allow for study replication and facilitate comparison of findings. The empirical model will be based on a system of simultaneous equations and will utilize Demographic and Health Surveys (DHS) data for Tanzania, Rwanda, and Angola. We will estimate the model using two-stage least squares with instrumental variables. Malaria will be quantified by parasitaemia (as measured by microscopy), reducing the potential bias observed in studies that considered fever as a proxy for malaria. SES will be measured by a wealth index based on household ownership of durable assets and on housing conditions. Instruments for estimating the effect of malaria on SES include pregnancy status, elevation, and precipitation; instruments for estimating the effect of SES on malaria include gender and ethnicity; distance to major towns; and total rainfall during the agricultural season(s). We will conduct statistical tests of instrument validity using a Sargan's test for over-identifying restrictions. Depending on the suitability of the instruments, we may need to use other methods for causal analysis (e.g. propensity score matching). We choose Tanzania, Rwanda, and Angola because recent DHS surveys included malaria parasite testing by microscopy, reducing the potential bias observed in studies that consider fever as a proxy for malaria. The DHS are nationally representative surveys and therefore comprise diverse settings: urban and rural, low and high malaria risk, poor and relatively wealthy; they also contain geographical information that allows for the assessment of spatial variations, facilitating the targeting of malaria control interventions. Our analytical and empirical models will allow for the evaluation of economic impacts of on- going control interventions that significantly reduced malaria incidence, which is a research priority for the current goals of malaria elimination. PUBLIC HEALTH RELEVANCE: proposed study will provide a framework for increased scientific investigation of the bi-directional malaria-poverty causality, facilitating cross-country comparisons. It has the potential to allow malaria-endemic countries to better select and target interventions that both reduce the malaria burden and promote poverty alleviation. The research will also prepare the way to assess the economic impact of malaria control efforts in different countries, a research priority toward current malaria elimination goals.

描述（申请人提供）：了解疟疾与贫困的恶性循环本研究的长期目标是：(a)建立一个概念框架，以理解疟疾与贫困之间潜在的双向因果关系；(b)对提出的概念框架进行实证检验；(c)就疟疾与社会经济地位（SES）之间的双重关系的严重程度提供证据；(d)设计新的调查工具，以便利衡量拟议的概念框架所包括但尚未在标准调查中使用的机制；(e)评估成功的疟疾控制干预措施的经济影响。作为实现这些长期目标的第一步，本R21应用程序的目标是对疟疾-贫困的双向因果关系进行分析和实证评估。我们将在文献综述的基础上提出一个影响疟疾与贫困之间联系的因素的概念框架，并通过提出这些联系在多个空间尺度上的可能变化来增加复杂性。该框架建立在对疟疾的系统看法之上；它将允许研究复制并促进结果的比较。经验模型将基于一个联立方程系统，并将利用坦桑尼亚、卢旺达和安哥拉的人口与健康调查（DHS）数据。我们将使用工具变量的两阶段最小二乘来估计模型。疟疾将通过寄生虫血症（通过显微镜测量）进行量化，从而减少在将发烧视为疟疾的替代指标的研究中观察到的潜在偏差。SES将以家庭拥有的耐用资产和住房状况为基础的财富指数来衡量。估计疟疾对SES影响的工具包括妊娠状况、海拔和降水；估计SES对疟疾影响的工具包括性别和种族；到主要城镇的距离；和农业季节的总降雨量。我们将使用萨根检验对过度识别限制进行仪器效度的统计检验。根据工具的适用性，我们可能需要使用其他方法进行因果分析（例如倾向得分匹配）。我们之所以选择坦桑尼亚、卢旺达和安哥拉，是因为最近的国土安全部调查包括了通过显微镜进行的疟疾寄生虫检测，从而减少了在将发烧视为疟疾代表的研究中观察到的潜在偏差。人口和健康调查是具有全国代表性的调查，因此包括不同的环境：城市和农村、低和高疟疾风险、贫穷和相对富裕；它们还包含地理信息，可用于评估空间变化，促进疟疾控制干预措施的针对性。我们的分析和经验模型将允许评估正在进行的控制干预措施的经济影响，这些干预措施显著降低了疟疾发病率，这是当前消除疟疾目标的研究重点。公共卫生相关性：拟议的研究将提供一个框架，以加强对疟疾与贫穷的双向因果关系的科学调查，促进跨国比较。它有可能使疟疾流行国家更好地选择和确定既能减轻疟疾负担又能促进减轻贫困的干预措施。这项研究还将为评估不同国家疟疾控制工作的经济影响铺平道路，这是当前消除疟疾目标的一个研究重点。