A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial of the Impact of Malaria Prevention on the Educational Attainment of School Children

Abstract

A double-blind, placebo-controlled trial of nine months duration was carried out to investigate the impact of malaria and its prevention on the educational attainment of school children in a malaria-endemic area in southern Sri Lanka where both Plasmodium falciparum and P. vivax infections are prevalent. A total of 587 children attending grades 1-5 in four schools and resident in the area were randomly allocated to chloroquine (n = 295) and placebo (n = 292) arms. Language and mathematics scores of end-of-term school examinations for 1998 and 1999 and number of days absent and reasons for absenteeism during seven months pre-intervention and nine months of the intervention were recorded. The results indicate that there were no differences in language (95% confidence interval [CI] = 48.44-53.78 in chloroquine group and 50.43-55.81 in placebo group) and mathematics (95% CI = 49.24-54.38 in chloroquine group and 51.12-56.38 in placebo group) scores between the two groups prior to the intervention. During the intervention, the malaria incidence rate decreased by 55% (95% CI = 49-61%) and school absenteeism due to malaria was reduced by 62.5% (95% CI = 57-68%) in children who received chloroquine compared with the placebo group. Post-intervention, children who received chloroquine scored approximately 26% higher in both language (95% CI = 21-31%) and mathematics (95% CI = 23-33%) than children who received placebo. In a multivariate model, educational attainment was significantly associated with taking chloroquine prophylaxis and absenteeism due to malaria (P < 0.001 for both) but not due to health causes other than malaria or non-health causes. Language scores were associated with number of malaria attacks (P < 0.022). Educational attainment was significantly better among children whose compliance to chloroquine prophylaxis was higher (P < 0.001). The data suggest that malarial attacks have an adverse impact on the educational attainment of the school child and prevention of these attacks significantly improves educational attainment of children living in malaria-endemic areas.

Improving Learning in Primary Schools of Developing Countries

“…Health and nutrition treatments mainly focus on the provision of micronutrients, school meals, or deworming medications. Malaria-related treatments are rarer, with only one included in the table's sample of studies (D. Fernando, de Silva, Carter, Mendis, & Wickremasinghe, 2006). Moreover, health and nutrition treatments are rarely applied in concert with either instructional or incentive-based treatments (for an exception, see Sylvia et al, 2012).…”

“…The pooled sample excludes three effect sizes, including a radio mathematics treatment that is both the earliest treatment as well as the largest effect size of 1.5 (Jamison et al, 1981). The sample also excludes language and math effect sizes from a malaria prevention treatment that was the only such treatment eligible for inclusion in the sample (D. Fernando et al, 2006).…”

Clusters of poverty and disease emerge from feedbacks on an epidemiological network

“…The first assumption is a universal property of neoclassical economic growth models [25]. The second assumption is based on a recently growing literature in economics and epidemiology that health status influences cognitive development, and schooling with long-term impacts on economic productivity [26][27][28]. The final assumption is based on the fact that prevention and treatment of infectious diseases requires economic resources, which is why poverty is a social determinant of disease.…”

Herd immunity acquired indirectly from interactions between the ecology of infectious diseases, demography and economics

“…However, over the relevant economic time (i.e. intergenerational time), the transmission rate is determined by this feedback between economics and epidemiology and is thus endogenous to the system (Nokes et al 1992;Holding & Snow 2001;Ezeamama et al 2005;Fernando et al 2006). We can build such feedbacks into our model system by making the transmission rate a function of income and income a function of health:…”

“…This is due to both (i) a direct effect of health on labour productivity and, perhaps more importantly, (ii) an indirect effect on labour productivity through the effect of childhood health on the acquisition of human capital-the training and education of the workforce. Diseases such as malaria and parasitic worms, among others, are known to directly interfere with childhood learning processes, and therefore ultimately undermine long-term economic success (Nokes et al 1992;Holding & Snow 2001;Ezeamama et al 2005;Fernando et al 2006). …”