Essays on the economics of malaria in the Sahel: case studies in Mali and Burkina Faso.

Summary The implementation of the Millennium Development Goals (MDGs) has resulted in significant but uneven progress across countries. Sub-Saharan African countries are still characterized by high proportions of out-of-school children, high infant mortality and a high burden of communicable diseases, including malaria, in the overall disease burden. Added to this is a high level of fertility with its potential economic consequences. The Sustainable Development Goals also target malaria for elimination by 2030 and advocate for quality education for all, including early childhood care, which had been overlooked in the MDGs. This thesis analyzes aspects of development related to these global challenges. The first chapter analyzes the impact of malaria control campaigns on fertility in Mali using Demographic and Health Survey data from 2006 and 2012 and Malaria Atlas Project data from the same period. The results show that malaria has a negative effect on fertility (-0.24 children). Among the mechanisms that explain this effect (infant deaths, abortions), maternal education is the most important mechanism. The second chapter examines the relationship between malaria, household income and investment in education through a randomized controlled trial in a village in Mali. Surveys were conducted in July and December 2016 among the same households, with microscopy malaria screening of children aged 3 months to 5 years. Results show that relaxing malaria-related economic loss constraints (direct costs, care expenses, and/or lost productivity) allowed households to save 3194 F CFA (5 euros) and make additional expenditures of 2863 F CFA (4 euros) in children's education. The third chapter, also a randomized controlled trial, analyzes the effect of reminder messages and information to household heads on the use and adoption of the impregnated mosquito net strategy using a cell phone platform in Bobo Dioulasso, Burkina Faso. Surveys were conducted in 2013, 2016 and 2017 to collect data from the same households. The results show that the problem of inappropriate use of malaria preventive care, can be solved using the classic health awareness method or by disseminating information messages to heads of households through their dissemination by a cell phone platform. The effect was between 4.6 and 6 percentage points for text and voice messages respectively. The fourth chapter analyzes the impact and cost of a set of health and education strategies (micronutrients, SPC, deworming) on improving early childhood development. This was a randomized controlled trial with villages as the unit of randomization, conducted in 2016 in an area of high malaria transmission and high anemia prevalence, Sikasso in southern Mali. The cost of the different strategies was evaluated from a provider perspective for a relatively short time horizon. The integrated strategies did not have an impact on early childhood development. However, the cost of implementing these strategies was limited. In conclusion, malaria is a burden on economic development, through effects on fertility and income, potentially penalizing investment in education. Our results therefore contribute to the existing literature on the effect of malaria on economic development.