An analysis of factors determining malaria incidence in India with particular reference to Uttar Pradesh

This thesis identies, inter alia, the socio-economic factors that affect malaria incidence at both the household and district levels and investigates how these differ across rural and urban settlement-types. In addition, state level data for India are used to examine the effect of aggregate income relative to that of public health expenditure on malaria incidence. The household and district-level analysis focuses on the state of Uttar Pradesh and exploits the National Family Health Survey, which is the Demographic Health Survey (DHS) for India, for two time periods - 1992-93 and 1998-99 - and combines these data with the district-level census data for 1991 and 2001. A key theme of the micro-level analyses is whether household wealth exerts a negative impact on malaria incidence. Wealth is measured using the DHS data by constructing a consumer durable asset-index by Principal Components Analysis and malaria incidence was modelled using a probability model. The household-level analysis reveals that the relationship between socio-economic status and malaria incidence is not always negative. For example, owning a water pump, indicative of a higher socio-economic status, has a positive impact on malaria incidence and being of a lower caste has a negative impact. Variables that support the negative socio-economic status and health relationship include having an electricity connection in the house, having access to a protected public drinking water supply rather than an open source, and living farther away from open water sources. The aggregate (or panel data) analysis was undertaken using data for 15 states in India covering the time period 1978 to 2000. The aggregate analysis reveals that income has a negative impact on malaria incidence but direct expenditure on health is more effective in bringing about a decline in malaria incidence - an increase of a rupee in aggregate income per person reduces malaria incidence by 0.1 percent whereas an equivalent increase in real health expenditure per capita results in 0.4 percent decline in malaria incidence. The research undertaken for this thesis is unique in using the DHS to identify the factors aecting malaria incidence and shows that these data are very useful in exploring the relationship between malaria incidence and a host of socio-economic factors in order to identify areas for effective policy intervention. Such a holistic approach is critical in controlling and, eventually, eradicating malaria rather than relying primarily on more direct treatment strategies based on insecticide-treated bed nets and drug therapy. The areas where public spending could be directed to attack malaria identied by the empirical analysis include education, particularly raising awareness on prophylactic measures through adult literacy centres, controlling the breeding of mosquitoes in open water collection sites such as public taps and around water pumps and improving water flow in agricultural fields to prevent stagnant water collection.