The Economic Impact of Screening Rural Houses as an Additional Vector Control against Malaria Transmission in Zambia

Malaria has been recognized as one of the important health concerns in developing countries, with dire economic consequences particularly in Sub-Sahara Africa. In Zambia, the disease accounted for 2000 deaths in 2016 while its prevalence among children under the age of 5 is as estimated to be as high as 30 percent in some rural parts of the country. In this study we seek to determine the socio-economic impacts of House Screening (HS), a malaria control intervention, which works by covering windows, doors and eaves of rural houses with wire mesh, thus protecting the entire households from mosquito bites. We also explores how to stimulate appropriate household behaviors using loss aversion and knowledge diffusion in order to optimize the outcomes of HS. There are several channels through which malaria impedes economic development. Apart from the immediate debilitating effects of morbidity and mortality, it imposes negative impacts on human capital including low productivity, low income and low educational attainment. Therefore, a study to determine the socio-economic impact of HS is necessary for understanding the full-scale impact of interventions that control malaria such as HS. Furthermore, understanding the cost effectiveness of the house screening intervention as well as the Cost Benefit Analysis (CBA) is essential for public health investment considerations. Behavior of households can have profound effects on the outcomes of malaria control interventions including HS. Behaviors such as hours residents spend indoors and outdoors at night have been considered as important in previous studies. Similarly, behaviors such as closing of doors, windows and maintenance of the house screens may have affects on the outcomes of the HS intervention. Using incentives to stimulate appropriate behavior has been studied in several domains. Incentives and nudges can significantly influence behavior to produce desired outcomes. Particularly, framing of incentives as losses has been observed to produce larger positive effects compared to gains - suggesting that the loss frame motivates behavior to a greater extent than the gain frame does. Furthermore, social networks have been identified as important channels for knowledge diffusion. Hence, diffusion of knowledge about house screening is likely to take place within social networks and this may affect their knowledge, behavior towards malaria prevention and willingness to pay for the technology among those who have not yet received it. This study contributes to the emerging literature on the impact of HS, loss aversion and social networks with potential application to health policies in developing countries