Maction Komwa [mkomwa@gmu.edu], PhD Candidate

George Mason University

Global Community Health

Fairfax, VA 22030

Cost-effectiveness approaches in the control 

of mosquitoes in developing countries:

A case study for Public Health Protection in Uganda & Zambia
Outline

 Main Objective

 Introduction

 Malaria and Lyme disease

 Intervention strategies

 Malaria and Lyme disease

 Environmental management 

/Home Management 

Malaria

 Lessons learned/conclusion
Questions to the audience?

 Are there any historical programs that have been 

used with the aim to eradicate Malaria or Lyme 

diseases?

 Were these programs a success or a failure?

Discuss Reasons...............
Main Objective

 To highlight cost-effective approaches to reduce mosquito 

infestations and ensure minimal exposure to humans 

through the analytical evaluation of mosquito behavior and 

control programs.

 To apply lessons learned from this analytical approach to the 

control program efforts of Lyme diseases 
Introduction

Similarities between Malaria & Lyme diseases

 Both are all transmitted through arthropods (insects or 

arachnids)

 Ticks & mosquitoes are classified as parasites 

 Transmit diseases to people by blood-sucking 

 Both diseases are strongly influenced by environmental factors.

 Both are of important public health parasites to be discussed

 Control of these can be partially attained through the spraying of 

insecticides or other methods of reducing the insect population 

such as Environmental Management
Malaria

 Malaria caused by one of the 4 types of 

protozoa is a major health problem in much 

of the tropics and subtropics.

 It is spread by mosquito bites

 The CDC estimates: 300-500 million cases 

of malaria each year, and more than 1 

million people die

Problem: Resistant to insecticides

 This has led to difficulty in controlling both 

the rate of infection and spread of the disease
Lyme disease 

 Lyme disease is most common tick-borne

illness in the northern hemisphere. 

Caused by infection with a bacterium called 

Borrelia burgdorferi.

 Spread by deer ticks bites that harbor 

the bacterium.

Just like malaria the disease if left 

undiagnosed, the effects can be devastating.

Arthritis and neurologic symptoms
• Malaria is a major public 

health problem in Uganda

• Accounting for 25-40% 

of all outpatient 

attendances, 

• 9-14% of admissions and 

a case fatality rate of 3% 

in Uganda (Republic of 

Uganda 2008).

Public Health Protection in Uganda

Source: Hopkins et L. 2008

Figure 1. Map of sentinel site health centers
Preventive interventions - malaria

 Strategies recommended for 

vector management in Uganda 

are:

 indoor spraying of houses with 

residual insecticides (IRS) and

 insecticide-treated bed nets 

(ITNs)

 Treatment through the use of 

anti-malaria drugs though 

mosquitoes are becoming drug 

resistant.
Lyme disease & Malaria control

 Deer tick often hides in shady moist places – this is 

also true with mosquitoes 

 Vegetation clearance around homes reduces the infestation of 

mosquitoes + ticks

 House or yard screening (for mosquitoes, tick identification

 Environmental management –Target life cycle of both diseases

 Modification of river boundaries, draining swamps, oil application 

to open water bodies

 Both malaria and Lyme diseases can be treated if 

diagnosed early so see a physician as early as possible
Treatment of – Lyme disease | Malaria

 Treatment of Lyme disease mostly with antibiotics.

 Long term use of anti-malaria drug or antibiotics for 

Lyme disease can have the following consequences:

 Costly

Inefficient and potentially harmful 

 Due to drug-resistant conditions

What are cost-effective preventative and control 

measures being used in malaria control that could be 

part of lessons to be applied to Lyme disease control?
Environmental Management to control 

Malaria
Understanding the Life cycle of the 

diseases
Cost-effectiveness of environmental management

Roll back malaria (RBM) : Case study of Zambia 

(Utzinger, et al. 2001)

 RBM – (1998) aimed at 

halving the burden of 

malaria by the year 2010 

 (Using Lessons learned from 

historical data.) HOW?



 Data Assembled (1929-

1949): 

 Results:

 3-5 Yrs

 70±95% low malaria related mortality, 

morbidity and incidence rates

 Estimated costs per disability adjusted life 

year (DALY) averted 

 were US$ 524±591.

 Within 20 years 

 Estimated 4173 deaths and 161 205 

malaria attacks.

 Estimated costs per death and malaria attack 

[US$ 858 and US$ 22.20 respectively]
Community low cost control measures 

Case study of Uganda

 Community-implemented malaria control programme

 Tailored strategy to the prevailing ecological & 

epidemiological conditions

 Understanding the ecological conditions which affect & 

regulate the distribution and abundance of mosquito 

populations.

 Local priorities depends on local resources in order to have 

sustainable program (through the support of government 

agencies).

 Home Management of Malaria
Community low cost control measures

– Case study of Uganda

 Home Management of Malaria

 Providing training of the community members as 

medicine distributors (travel cost reduction to clinics)

 Distribution of anti-malarial medicines

 Campaign, and community sensitization to caregivers 

(Adherence by caregivers, home cleanliness campaign 

etc.)

 Accessibility of anti-malarial medicine in many villages

 “bring appropriate drugs closer to home”

 Availability of anti-malarial medicine at an affordable 

price
Efforts by Volunteers 

 Volunteers from the community (Community Medicine 

Distributors (CMD) are trained

 Normally two are selected per village and trained

 They evaluate and treat febrile children and are provided with antmalarial drugs to household care takers

 CMDs report to the nearest Health facility for supplies etc.

 This is part of cost-effective since household caretakers 

don’t travel a long distance to seek for emergency 

treatment

 Risks are minimized (a journey of 5km to the nearest clinic including 

poor infrastructure can ultimately reduce preventable conditions and 

deaths)
Advantages of community low cost control measures 

Likely to be most effective and cost-effective in 

areas with high malaria transmission

Limited health care infrastructure

Poor access to ant-malarial treatment

Communities understand that malaria is the main 

killer disease therefore becomes excited to 

participate.

Lubell, et al. 2010
Funding of community based control programs

 National Malaria Control Programme (NMCP) & 

MoH

 Private Sector in Uganda

 Non-governmental organizations

 WHO-Geneva through the Makerere University 

 U.S. President’s Malaria Initiative (PMI)

 UNICEF-UNDP-WORLD BANK-WHO Special 

Programme for Research and Training in Tropical 

Diseases (TDR)
Difference between Uganda & US

 The control program of these diseases are scientific, 

technical activity that requires skilled personnel

The majority of Ugandans are not well educated 

compared to US so this can have different settings

 Availability of local resources will dictate local 

priorities.

 Funding is a problem and as a result in Uganda most 

villages rely on community efforts to sustain their 

programs.
Lessons learned

 Considering the similarities of the behavior of mosquitoes 

and ticks behavior employing both prevention 

interventions combined with alternative low cost 

strategies can help to reduce malaria and Lyme diseases.

Community efforts in Uganda can be a foundation 

for further research that could help to develop 

effective local strategies that can ensure 

sustainability.

Historical studies can help to modify strategies to 

control mosquitoes and likely ticks infestation.
Conclusion

 Ticks, and mosquitoes will continue to be important public 

health parasites for discussions.

 Effective control measures will not only be measured by the 

effectiveness of a particular method or combination of methods, 

but also in the methodology that will ensure sustainability and 

minimal exposure to humans.

 Community involvement & institutional participation could also 

strengthen the control measures.

 Environmental management has a long-term track record of 

successful malaria control in a diversity of ecological, 

epidemiological and socio-economic settings.

 Specific control strategies should be developed for specific

country conditions 
References

 Ajayi, I.O. et al. 2008. Effectiveness of artemisinin-based combination therapy used in the context of 

home management of malaria: A report from three study sites in sub-Saharan Africa Malaria Journal, 

7:190. 

 Centers for Disease Control & Prevention. Malaria. http://www.cdc.gov/malaria/

 Hopkins, H. et al. 2008. Rapid Diagnostic Tests for Malaria at Sites. of Varying Transmission Intensity in 

Uganda JID 2008:197 (15 February)

 Jacobson, K. H. (2008). Introduction to global health. Sudbury, MA: Jones and Bartlett Publishers. 

 LubellY, Mills AJ, Whitty CJM, Staedke SG (2010) An Economic Evaluation of Home Management of 

Malaria in Uganda: An Interactive Markov Model. PLoS ONE 5(8): e12439. 

doi:10.1371/journal.pone.0012439



Utzinge et al. 2001. Effcacy and cost-effectiveness of environmental management for malaria control. 

Tropical Medicine and International Health. 6:9 pp 677-687
Thank you
Discussions