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The incidence of malaria in Solomon Islands has been decreasing since 1992. The control program used a combination of methods including DDT residual house spraying and insecticide-treated mosquito nets. To determine how much each method contributed to malaria control, data were analyzed on monthly incidence and on control activities for 41 of 110 malaria zones over the same time period (January 1993 to August 1999). After correction for endogeneity, then spraying, insecticide treatment of nets, and education about malaria are all independently associated with reduction in incident cases of malaria or fever, while larviciding with temephos is not. The evidence suggests that although impregnated bed nets cannot entirely replace DDT spraying without substantial increase in incidence, their use permits reduced DDT spraying. The paper shows that non-experimental data can be used to infer causal links in epidemiology, provided that instrumental variables are available to correct for endogeneity.
Received September 3, 2003. Accepted for publication October 3, 2003.
Acknowledgments: This project was a collaboration between the Development Research Group and the East Asia and Pacific Region Human Development Sector (EASHD), World Bank, as a contribution to the preparation of the Solomon Islands Health Sector Development Project. We thank Janet Hohnen and Rekha Menon of the EASHD for encouraging this work, the Ministry of Health and Medical Services, Solomon Islands, for permission to carry it out, and the Vector-Borne Disease Control Program for providing the data for this study. In particular, we are grateful to Dr. Dennie Iniakwala, Dr. George Malefoasi and Dr. Lester Ross for their support. We are very grateful to the following people for expert assistance and support: Albino Bobogare, Hugo Bugoro, Tom Burkot, Henry Harrington, Luke Honiola, Oscar Jance, Ben Kaefia, Jerry Keusch, Eric Ladofooa, Landry Losi, Julie McLaughlin, Basil Mfane, Mark Miller, Jennifer Mitini, Kevin Palmer, Andrew Sulifoa, and Makiva Tuni. We also thank the Solomon Islands Meteorological Office, the Department of Development Planning, and the Census Office (funded by the European Union) for providing data for this study.
Financial support: The following organizations supported the malaria control program during the period under study: the Solomon Islands Government, the World Health Organization, the Australian Agency for International Development, the Secretariat for the Pacific Community, the United Nations Development Program, and the Rotarians Against Malaria project. The World Bank provided funds for data collection and analysis for this study.
Disclaimer: The findings, interpretations, and conclusions expressed in this report are entirely those of the authors and do not necessarily represent the views of the World Bank, its Executive Directors, or the countries they represent.
Authors addresses: Mead Over, Development Research Group, World Bank, 1818 H Street NW, Washington DC 20433, Telephone 202-473-3451, Fax 202-522-1154, E-mail: meadover{at}worldbank.org. Bernard Bakotee and Peter Wilikai, Ministry of Health and Medical Services, PO Box 349, Honiara, Solomon Islands, Telephone: 677-30655/38208 and 677-20830, Fax: 677-20085, E-mail: closol{at}who.org.sb. Raman Velayudhan, World Health Organization, PO Box 22, Honiara, Solomon Islands, Telephone 632-528-8001, Fax 632-521-1036, E-mail: velayudhanr{at}phl.wpro.who.int. Patricia M. Graves, Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, 4200 E. Ninth Avenue, Denver, CO 80262, Telephone: 970-484-4693, Fax: 970-484-0440, E-mail: patriciagraves{at}attglobal.net.
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