Katherine L. Dickinson

Deforestation, malaria, and poverty: a call for transdisciplinary research to support the design of cross-sectoral policies

Abstract Many of the world’s poorest people live in areas with high malaria rates and suffer the associated physical, economic, and social hardships. These same areas are often undergoing extensive forest conversion and degradation. While causality has generally not been established, the scientific literature makes it abundantly clear that the juxtaposition of deprivation, deforestation, and disease is not pure coincidence. We chart a course for using transdisciplinary research to develop more effective policies to control malaria, protect forests, and alleviate poverty. First describing the malaria problem, including its etiologic roots and its social toll, the paper then examines some shortcomings of contemporary societal responses. We discuss why understanding the role of deforestation in linking malaria to poverty is important and present the mixed empirical evidence on the malaria-deforestation-poverty link from macro- and microeconomic studies. The paper concludes with a proposal for strategically linking research and policy at the malariadeforestation- poverty nexus in a comprehensive decision-analysis framework that channels research to the most pressing policy needs, informs policy with the most conclusive research, and ensures stakeholders are effectively informed about their options.

Using Decision Analysis to Improve Malaria Control Policy Making

Malaria and other vector-borne diseases represent a significant and growing burden in many tropical countries. Successfully addressing these threats will require policies that expand access to and use of existing control methods, such as insecticide-treated bed nets (ITNs) and artemesinin combination therapies (ACTs) for malaria, while weighing the costs and benefits of alternative approaches over time. This paper argues that decision analysis provides a valuable framework for formulating such policies and combating the emergence and re-emergence of malaria and other diseases. We outline five challenges that policy makers and practitioners face in the struggle against malaria, and demonstrate how decision analysis can help to address and overcome these challenges. A prototype decision analysis framework for malaria control in Tanzania is presented, highlighting the key components that a decision support tool should include. Developing and applying such a framework can promote stronger and more effective linkages between research and policy, ultimately helping to reduce the burden of malaria and other vector-borne diseases.

Catching fire? Social interactions, beliefs, and wildfire risk mitigation behaviors

Social interactions are widely recognized as a potential influence on risk-related behaviors. We present a mediation model in which social interactions (classified as formal/informal and generic/fire-specific) are associated with beliefs about wildfire risk and mitigation options, which in turn shape wildfire mitigation behaviors. We test this model using survey data from fire-prone areas of Colorado. In several cases, our results are consistent with the mediation hypotheses for mitigation actions specifically targeting vegetative fuel reduction. Perceived wildfire probability partially mediates the relationship between several interaction types and vegetative mitigation behaviors, while perceptions of aesthetic barriers and lack of information play a mediating role in the case of fire-specific formal interactions. Our results suggest that social interactions may allow mitigation and prevention behaviors to “catch fire” within a community, and that wildfire education programs could leverage these interactions to enhance programmatic benefits.

Insecticide Resistance and Malaria Vector Control: The Importance of Fitness Cost Mechanisms in Determining Economically Optimal Control Trajectories

ABSTRACT The evolutionary dynamics of insecticide resistance in harmful arthropods has economic implications, not only for the control of agricultural pests (as has been well studied), but also for the control of disease vectors, such as malaria-transmitting Anopheles mosquitoes. Previous economic work on insecticide resistance illustrates the policy relevance of knowing whether insecticide resistance mutations involve fitness costs. Using a theoretical model, this article investigates economically optimal strategies for controlling malaria-transmitting mosquitoes when there is the potential for mosquitoes to evolve resistance to insecticides. Consistent with previous literature, we find that fitness costs are a key element in the computation of economically optimal resistance management strategies. Additionally, our models indicate that different biological mechanisms underlying these fitness costs (e.g., increased adult mortality and/or decreased fecundity) can significantly alter economically optimal resistance management strategies.

Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana (REACCTING): study rationale and protocol

BackgroundCooking over open fires using solid fuels is both common practice throughout much of the world and widely recognized to contribute to human health, environmental, and social problems. The public health burden of household air pollution includes an estimated four million premature deaths each year. To be effective and generate useful insight into potential solutions, cookstove intervention studies must select cooking technologies that are appropriate for local socioeconomic conditions and cooking culture, and include interdisciplinary measurement strategies along a continuum of outcomes.Methods/DesignREACCTING (Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana) is an ongoing interdisciplinary randomized cookstove intervention study in the Kassena-Nankana District of Northern Ghana. The study tests two types of biomass burning stoves that have the potential to meet local cooking needs and represent different “rungs” in the cookstove technology ladder: a locally-made low-tech rocket stove and the imported, highly efficient Philips gasifier stove. Intervention households were randomized into four different groups, three of which received different combinations of two improved stoves, while the fourth group serves as a control for the duration of the study. Diverse measurements assess different points along the causal chain linking the intervention to final outcomes of interest. We assess stove use and cooking behavior, cooking emissions, household air pollution and personal exposure, health burden, and local to regional air quality. Integrated analysis and modeling will tackle a range of interdisciplinary science questions, including examining ambient exposures among the regional population, assessing how those exposures might change with different technologies and behaviors, and estimating the comparative impact of local behavior and technological changes versus regional climate variability and change on local air quality and health outcomes.DiscussionREACCTING is well-poised to generate useful data on the impact of a cookstove intervention on a wide range of outcomes. By comparing different technologies side by side and employing an interdisciplinary approach to study this issue from multiple perspectives, this study may help to inform future efforts to improve health and quality of life for populations currently relying on open fires for their cooking needs.

Nature’s Call: Impacts of Sanitation Choices in Orissa, India

Worldwide, over 2.5 billion people lack access to basic sanitation, a situation that contributes to 2 million annual diarrhea-related child deaths and substantial morbidity. Yet rigorous evaluations of sanitation behaviors and their health and welfare impacts are rare. This article uses a randomized sanitation promotion campaign in Orissa, India, to evaluate child health and household welfare outcomes. The sanitation campaign increased households’ ownership and use of latrines and improved children’s mid-upper-arm circumference, height, and weight z-scores. Switching from open defecation to latrine use also saved time and increased satisfaction in sanitation conditions. We use our results to illustrate the cost-benefit calculus underlying this seemingly unglamorous and mundane household choice with potentially large environmental externalities.

Awareness and support of release of genetically modified "sterile" mosquitoes, Key West, Florida, USA.

After a dengue outbreak in Key West, Florida, during 2009–2010, authorities, considered conducting the first US release of male Aedes aegypti mosquitoes genetically modified to prevent reproduction. Despite outreach and media attention, only half of the community was aware of the proposal; half of those were supportive. Novel public health strategies require community engagement.

Socio-economic status and malaria-related outcomes in Mvomero District, Tanzania.

While policies often target malaria prevention and treatment – proximal causes of malaria and related health outcomes – too little attention has been given to the role of household- and individual-level socio-economic status (SES) as a fundamental cause of disease risk in developing countries. This paper presents a conceptual model outlining ways in which SES may influence malaria-related outcomes. Building on this conceptual model, we use household data from rural Mvomero, Tanzania, to examine empirical relationships among multiple measures of household and individual SES and demographics, on the one hand, and malaria prevention, illness, and diagnosis and treatment behaviours, on the other. We find that access to prevention and treatment is significantly associated with indicators of households’ wealth; education-based disparities do not emerge in this context. Meanwhile, reported malaria illness shows a stronger association with demographic variables than with SES (controlling for prevention). Greater understanding of the mechanisms through which SES and malaria policies interact to influence disease risk can help to reduce health disparities and reduce the malaria burden in an equitable manner.

Environmental management for malaria control: knowledge and practices in Mvomero, Tanzania.

Environmental conditions play an important role in the transmission of malaria; therefore, regulating these conditions can help to reduce disease burden. Environmental management practices for disease control can be implemented at the community level to complement other malaria control methods. This study assesses current knowledge and practices related to mosquito ecology and environmental management for malaria control in a rural, agricultural region of Tanzania. Household surveys were conducted with 408 randomly selected respondents from 10 villages and qualitative data were collected through focus group discussions and in-depth interviews. Results show that respondents are well aware of the links between mosquitoes, the environment, and malaria. Most respondents stated that cleaning the environment around the home, clearing vegetation around the home, or draining stagnant water can reduce mosquito populations, and 63% of respondents reported performing at least one of these techniques to protect themselves from malaria. It is clear that many respondents believe that these environmental management practices are effective malaria control methods, but the actual efficacy of these techniques for controlling populations of vectors or reducing malaria prevalence in the varying ecological habitats in Mvomero is unknown. Further research should be conducted to determine the effects of different environmental management practices on both mosquito populations and malaria transmission in this region, and increased participation in effective techniques should be promoted.

Post Outbreak Review: Dengue Preparedness and Response in Key West, Florida

Dengue is the most prevalent mosquito-borne viral infection. Recent outbreaks in the southern United States illustrate the risk of reemergence. The first autochthonous cases since 1934 in Key West, FL, occurred in 2009-2010. We conducted a survey in 2012 with decision makers instrumental to the control of the outbreak to 1) determine their awareness of the multiple strategies used to control the outbreak and 2) assess their perceptions of the relative effectiveness of these strategies. An online survey was delivered to a predefined list of decision makers from multiple sectors to better understand dengue preparedness and response. Thirty-six out of 45 surveys were returned for an 80% response rate. Results indicate the need to focus prevention strategies on educational campaigns designed to increase population awareness of transmission risk. Respondents remain concerned about future dengue transmission risk in Key West and lack of resources to respond.