which was 7 percent of household income (Ettling et al., 1994). Total household costs were estimated at 9-18 percent of annual income for small farmers in Kenya, and 7-13 percent in Nigeria (Leighton and Foster, 1993).

One multicountry study has attempted an Africa-wide estimate of direct plus indirect costs of malaria based on extrapolations from four case studies of areas in Burkina Faso, Chad, Congo, and Rwanda. The totals reported were US$1,064 million overall, which translates to US$3.15 per capita and 0.6 percent of total sub-Saharan Africa GDP (in 1987, inflated to 1999 U.S. dollars) (Shepard et al., 1991). Two of the country case studies estimated household plus government costs (including the direct costs of treatment, but not prevention; and including indirect mortality costs). The national cost per capita was estimated at US$1.55 in Burkina Faso (Sauerborn et al., 1991), and US$3.87 in Rwanda (Ettling and Shepard, 1991), figures that were roughly equivalent to 3.5 days of individual production.

The studies reported here vary widely in the details of the methodology, their sources of data, and in their perspectives. Comprehensive studies of this type are difficult to conceive and to carry out, given inherent limits on data available in the places most affected, general difficulties in carrying out research in such places, and a lack of funding for such studies. Even when done well, however, the methods often require assumptions about such things as employment levels (which affect whether wages are actually lost), the value of leisure time, and substitutability of work by other families. Some of the aspects not generally captured by the human capital method relate to coping strategies adopted by families, which affect their economic well-being in ways not usually measured through direct and indirect costs usually measured.

In addition to paying for malaria prevention and treatment with cash-on-hand, and losing wages and other productive labor, families cope with malaria in ways that diminish their overall economic wellbeing. They respond not only to actual episodes of illness, but to the risk of illness with “anticipatory” coping strategies. These are often ignored in quantitative analyses because they may be hidden, and are at best, difficult to quantify.

Families faced with paying extraordinary costs for malaria treatment may:

Front Matter (R1-R20)

Executive Summary (1-16)

Part 1: A Response to the Current Crisis1 Malaria Today (17-60)

2 The Cost and Cost-Effectiveness of Antimalarial Drugs (61-78)

3 The Case for a Global Subsidy of Antimalarial Drugs (79-111)

4 An International System for Procuring Anitmalarial Drugs (112-122)

Part 2: Malaria Basics5 A Brief History of Malaria (123-135)

6 The Parasite, the Mosquito, and the Disease (136-167)

7 The Human and Economic Burden of Malaria (168-196)

8 Malaria Control (197-251)

9 Antimalarial Drugs and Drug Resistance (252-298)

Part 3: Advancing Toward Better Malaria Control10 Research and Development for New Antimalarial Drugs (299-311)

11 Maximizing the Effective Use of Antimalarial Drugs (312-328)

Acronyms and Abbreviations (329-333)

Glossary (334-346)

Index (347-364)