weight, due to prematurity and intra-uterine growth retardation. Low birth
weight is associated with health problems much later in adult life. Malaria
seems to interact with other common diseases such as measles, respiratory
infections, diarrhoeal disease and malnutrition in ways that are still not well
understood. Despite these data problems various small-scale studies have tried
to quantify the impact of malaria. The direct costs of malaria include expendi-
ture on prevention and treatment of malaria by households and health services.
In the early 2000s evidence from Malawi indicated that expenditure on treat-
ment was over 25 per cent of household income among very low-income house-
holds. For Rwanda it was estimated that nearly 20 per cent of the Ministry of
Health budget went on treating malaria. In Kenya primary school children were
estimated to have on average four episodes of malaria per year and to miss on
average five days of school per episode, representing 11 per cent of the Kenyan
school year. Total costs have been estimated at anything from 7 to 32 per cent of
household annual income in Sub-Saharan Africa (Chima et al., 2003).
A larger-scale study is the case of India in the 1950s where there were rela-
tively successful efforts to eliminate malaria through the use of DDT
(dichlorodiphenyltrichloroethane) spraying. In 1947 India suffered an esti-
mated 75 million cases of malaria annually leading to 800,000 deaths, imply-
ing an incidence rate of 22 per cent across the whole population. The number
of malaria cases (estimated using blood smear tests) fell to 100,000 per year by
1965 and statistics on causes of death indicate that the number of malaria
deaths between 1952 and 1963 dropped by 91.2 and 98.3 per cent in the states
of Uttar Pradesh and West Bengal. DDT was subsequently banned and though
malaria prevalence remained stable in the 1960s there was a resurgence in the
1970s that peaked in 1976, though this new peak prevalence was only 1.1 per
cent across the whole population. This effort to reduce or eradicate malaria was
associated with a modest relative increase in income (proxied by per capita
household expenditure) for working-age men but no observed increase for
women. The most likely reason for this difference is that women have much
lower labour force participation rates than men (Cutler et al.,2010).
There is good econometric evidence to show that malaria does impact on
economic growth. Gallup and Sachs (1999) examined the relation of malaria to
GDP growth per capita between 1965 and 1990 using a malaria index (calcu-
lated as the fraction of the land area with endemic malaria in 1965 and the frac-
tion of malaria cases that were Plasmodium falciparum in 1990). Their results
suggest that countries with a substantial amount of malaria grew 1.3 per cent
per annum less on average and that a 10 per cent reduction in malaria was asso-
ciated with 0.3 per cent higher growth per year. Gallup and Sachs (2000) note
that by the late 1990s 54 countries (29 per cent of the world’s population) had
intensive exposure to malaria and 35 of them were in Africa. The average
income in countries with intensive malaria was $1,526 and in those without
$8,268. A number of growth accelerations can be dated from the eradication of
malaria, including in Greece, Italy and Spain from the early 1950s, Taiwan in
1961, Jamaica 1958 and the southern US from the 1950s.
244 Patterns and Determinants of Economic Growth