Economic burden of malaria on developing countries: A mini review

Abstract

Malaria remains a major public health challenge in developing nations, particularly in sub-Saharan Africa, with profound economic implications. This study examines the economic burden of malaria by analyzing its effects on economic growth, labor productivity, healthcare expenditure, and overall economic stability. A systematic literature review was conducted using databases such as PubMed, Google Scholar, JSTOR, Web of Science, MEDLINE, and EMBASE, with search terms including “Malaria,” “Economic Costs,” “GDP Effect,” “Labor Productivity,” “Health Care Expenditure Impact,” and “Economic Growth.” The search was restricted to studies published between 2000 and 2023, excluding those lacking quantitative data or precise economic evaluations. Findings indicate that malaria significantly hampers GDP growth, reduces investment, and negatively impacts the tourism sector and human capital development. The disease contributes to high absenteeism and presentism, particularly in the agricultural sector, exacerbating poverty and food insecurity. Both direct and indirect economic costs impose a substantial burden on healthcare systems, households, and public services, creating poverty cycles and increasing debt among affected populations. To mitigate these effects, the study underscores the need for strengthened healthcare systems, enhanced prophylactic interventions, sustained research and development, economic support programs, and global collaboration. Given the significant impact of malaria on the health and economic status of nations, tackling both its health and economic effects will fast tract the attainment of sustainable development especially in malaria-endemic countries.

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1. Introduction

Malaria is caused by Plasmodium parasites, which are conveyed to humans by the bite of infected female Anopheles mosquitoes (Graumans et al., 2020). Five species of Plasmodium are responsible for malaria in humans: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi(Djihinto et al., 2022). The principal form of transmission is the bite of an infected Anopheles mosquito; however, other pathways include blood transfusions, organ transplants, sharing of contaminated needles, and congenital transfer from mother to foetus (Djihinto et al., 2022). The life cycle of Plasmodium comprises the mosquito stage (sporogony), the human liver stage (exo-erythrocytic cycle), and the blood stage (erythrocytic cycle) (Commentary: Malaria Control in the 1990, 2025; World Malaria Report 2024, 2025; Djihinto et al., 2022). Risk factors for malaria include endemic locations, inadequate vector management, absence of immunity in young children, pregnant women, and travelers, as well as climatic circumstances conducive to mosquito proliferation (Alum et al., 2024; Ekpono et al., 2019). Symptoms include fever, chills, muscle aches, headaches, and fatigue (Erisa et al., 2023). Microscopy and rapid diagnostic tests are used to diagnose the condition (Egwu et al., 2022). Antimalarial drugs are used for treatment, and the selection will depend on the parasite species and the drugs' resistance (Rasmussen et al., 2022). The prevention strategies include the use of mosquito control measures, prophylactic products, and vaccines. Tropical and sub-tropical regions are endemic to malaria, with children, pregnant women, and travelers from temperate zones typically being at risk (Egwu et al., 2023).

Global malaria cases reached 249 million in 2022, an increase of five million over 2021. In 2020, 241 million cases and 627 thousand deaths of malaria were estimated worldwide (World Malaria Report 2023, 2025). In nations with severe malaria prevalence, the GDP grew 1.3 % less per person per year after taking into account pertinent social and economic aspects (Gallup and Sachs, 2001). Global spending on malaria climbed by 8.6 % yearly between 2000 and 2016, reaching $4.3 billion, based on estimates by Haakenstad and colleagues (Haakenstad et al., 2019). The estimates covered the costs of treating and preventing malaria and were primarily based on national accounting systems from 106 countries. The malaria stratification principle optimizes intervention selection based on local context, considers financial resources, and enables governments to achieve the best outcomes with limited resources (A Framework for Malaria Elimination, 2025). In 2019, the WHO Regional Office for Africa introduced a costing tool for malaria control program budget planning, but it lacks service assessment and indirect costs (User Guide for the Malaria Strategic and Operational Plan Costing Tool, 2024). Two reviews on the economic burden of malaria exist: one in 2003 (Chima et al., 2003), which estimated monthly per capita expenditures for prevention and treatment, and the other in 2016 (Shretta et al., 2016), which focused on the economic and financial costs of malaria control, elimination, and eradication without considering treatment costs. The first study focused on African countries, ignoring treatment costs, while the second analyzed the economic and financial costs of malaria control, elimination, and eradication without considering the treatment costs, either direct or indirect. Malaria is a serious global health problem in most developing countries, particularly in sub-Saharan Africa, South Asia, and Latin America. Malaria is not only a health hazard for these regions, but it also has an impact on their economies (Fact Sheet About Malaria, 2025). This review article thus intends to demonstrate the impact of malaria on economic growth and development, labor productivity and earnings, healthcare costs, and economic stability and instability in malaria-prone regions using economic theories, facts, and evidence provided by public health professionals and policy advocates. Dissecting the economic cost of malaria will improve interventions aimed at achieving sustainable development in malaria-endemic countries.

2. Methodology

The data from this study involved conducting an extensive search in databases including PubMed, Google Scholar, JSTOR, Web of Science, MEDLINE, and EMBASE for the economic effect of malaria in developing countries, particularly in the sub-Saharan region. Search terms comprised “Malaria,” “Economic Costs,” “Developing World,” “GDP Effect,” “Labor Productivity,” “Health Care Expenditure Impact,” “Economic Growth,” “Human Capital Formation,” “Prophylactic Interventions,” and “Global Partnership.”, “Economic Burden” We limited this search to papers published between 2000 and 2023, eliminating those that lacked quantitative information or provided imprecise economic evaluation. We also conducted peer review to enhance the validity and credibility of the collected information. We integrated the results into a comprehensive and unified narrative, which included clear suggestions for future development of public health and economic policy in malaria-endemic countries.

2.1. Impact of malaria on economic growth

This has significant implications for the economic growth process, since malaria directly and indirectly reduces the economy's growth potential. The disease has adverse repercussions on human capital, decreases labor productivity, and hinders long-term economic growth.

• 1.Impact on GDP: Malaria poses a threat to national and even global economic development. Literature has revealed that increased malaria transmission may lead to slower economic growth in endemic countries, ranging from 0.7 to 3 % per year. Several factors, including reduced labor productivity and increased health-related costs, contribute to this (Singh et al., 2019). Jowett and Miller examined Tanzania's financial cost of malaria. According to the report, the disease accounts for more than 1 % of GDP, or US$2.2 per person, or $39 % of total health expenditures, with considerable contributions from the commercial and public sectors (Jowett and Miller, 2005). According to a recent study by Andrade and colleagues, the cost of treating malaria has reached 1.1 % of GDP and 39 % of public health spending, with families carrying the majority of the cost (71 %), followed by the government (20 %) (Andrade et al., 2022).
• 2.Investment and Tourism: Countries that are malaria-endemic are known to have little or no investments from foreign markets and low numbers of visitors to their tourism destinations. Tourism contributes significantly to global GDP, employment, and exports, accounting for 10.4 %, 10 %, and 6.8 %, respectively (Menegaki, 2020). Research shows that malaria, yellow fever, dengue, and ebola significantly impact global tourism, causing a decline (Rosselló et al., 2017). Malaria caused a 47 % decline in tourist arrivals, and the Zika virus outbreak caused a $3.5 billion loss in major sporting events in Latin America (Hall et al., 2020). Pandemics have a negative impact on tourism geography, affecting GDP growth, the business environment, trade openness, employment rates, spatial development, sustainable resource politics, transportation facilities, and the state image (Mostafanezhad et al., 2020). Travel is critical to epidemiology and disease surveillance, resulting in the rapid spread of pandemics and a tourism halt (Demir et al., 2019; Gössling et al., 2020). Tourists and investors can also opt not to visit malaria-endemic areas, thus limiting the economic progress of a given nation. This reluctance affects not only direct investments, but also the related industries that follow investments in these sectors (Nonvignon et al., 2016).
• 3.Human Capital Development: Malaria in children can also delay key educational milestones and hamper cognitive and learning abilities, ultimately causing population-wide knowledge gaps and additional economic losses in the labor force (Tapajós et al., 2019). This in turn has an impact on the country's potential for advancement, as the future workforce is not open to large amounts of productivity and innovation. The economic costs associated with malaria-related mortality among children aged 1–4 years were estimated at US$ 13,800 in Ghana, US$ 8900 in Kenya, and US$ 8100 in Tanzania, respectively (Sicuri et al., 2013).

2.2. Impact of malaria on workforce productivity

Malaria can indirectly impact productivity due to sick leave, lost work productivity, and time spent seeking treatment. Malaria causes a lot of absenteeism, in which the affected individual fails to go to work. In Brazil, the number of workdays lost per episode of malaria is about 2 (Devine et al., 2019) and 11 days in high-transmission areas of India (Singh et al., 2019). Absence from work results in the loss of a significant proportion of income or earnings. A study in Côte d'Ivoire found that malaria accounted for 8–9 days of absence, accounting for 58 % of the sick days among cabbage farmers. This study found a correlation between absenteeism, crop yields, and revenue, with decreased crop production due to sickness-related absenteeism (Girardin et al., 2004). Further, there is a particular trend known as presenteeism, which means that workers are present at their workplace but do not demonstrate their full potential because of illness (Lohaus et al., 2021). All these factors contribute to the overall cost of diminishing the workforce's productivity and efficiency. Malaria also significantly affects the agricultural sector in many endemic areas. The severity of malaria often prompts individuals to seek treatment and sometimes a break from work, posing a significant concern for agricultural productivity (Lukwa et al., 2019). Most workers in the agricultural sector receive their pay based on output or production, which means that the medical costs incurred during treatment and lost earnings contribute to the economic costs of disease transmission (Yogyorn et al., 2021). In Southeast Ethiopia, horticultural workers' absenteeism due to sickness accounted for 58.8 % of all days lost, with malaria accounting for 23.6 % of the lost days (Tadesse et al., 2015). The study in Côte d'Ivoire found that farm workers who were sick for more than two days experienced 47 % lower yields and 53 % lower revenues compared to those who missed only two days (Girardin et al., 2004). Therefore, during periods of high malaria mosquito exposure, farmers and farmhands often become incapacitated, leading to a reduction in agricultural productivity, which directly impacts food security and economies in rural areas. Malaria can also have an impact on child labor and education. Malaria can have a significant impact on families' income, encouraging children to work instead of attending school, thereby exacerbating poverty and hindering their future ability to improve their income levels (Tusting et al., 2016). This labor shift may also result in the long-term availability of lower-quality workers. The reduction of malaria in Sri Lanka's most affected region resulted in a projected 17 % increase in literacy (Lucas, 2010).

3. Malaria impact on healthcare costs

Research demonstrates that malaria significantly impacts the healthcare systems of developing countries, diverting resources from other areas and contributing to the overall cost of healthcare. The direct costs of malaria include medical expenses for treatment and hospitalization, doctor's fees, drugs, and laboratory fees (Du et al., 2020). In many developing countries, these costs represent a major financial constraint, both for household and public health system budgets (Sanoussi et al., 2023). Indirect costs include loss of production due to sickness and fatalities (Song et al., 2015). Studies indicate that malaria can cost up to $150, equivalent to 6 % of a household's total spending on health in lost earnings per episode, even when public sector primary health care is free (Purdy et al., 2013). It is also economically devastating because the loss of adult labor and the mortality of infants and children have a long-term economic impact on families and communities (Miller and Belizán, 2015). Malaria accounts for a significant amount of public health expenditure. Furthermore, malaria control and treatment in endemic countries consume a significant percentage of the country's health budgets and may deprive the country of major investments in other essential health areas (Elnour et al., 2023). Stuckey and colleagues estimated the annual costs of distributing long-lasting insecticide-treated bednets, indoor residue spray, and screening for schoolchildren in Nyanza Province, Kenya, at $179.50–$234.17 per capita (Stuckey et al., 2014).

3.1. Impact of malaria on economic stability

Malaria is a significant destabilizing factor that negatively affects an economy in a number of ways. From a macroeconomic standpoint, a region's economy will undoubtedly suffer if malaria affects the majority of its population, leading to decreased productivity and higher treatment expenses. This can lead to increased national debt and financial instability in the country (Patouillard et al., 2023). Malaria can also leave families in poverty due to high medical bills and a loss of income. Households use up assets or borrow money at high rates to cover the costs associated with malaria, resulting in a vicious cycle of poverty (Alonso et al., 2019). Wiseman and colleagues found that in Gambia, households spent significantly on malaria preventive activities; the vast majority of household spending was on consumables such as insecticide sprays, mosquito coils, and repellents (Wiseman et al., 2006). In Tanzania, most malaria preventive spending was on mosquito nets (Somi et al., 2007). In Kenya, the mean direct cost burdens were 7.1 % and 5.9 % of total household expenditure in the wet and dry seasons, respectively (Chuma et al., 2006). In Southeast Nigeria, the average cost of malaria treatment is 796.5 Naira ($6.64) for adults and 789.0 Naira ($6.58) for children. Malaria treatment accounted for 7.1 % and 5.0 % of non-food expenditures for rural and urban dwellers, respectively (Onwujekwe et al., 2010). Malaria has a significant influence on education, and this is worrying. One consistent pattern is that illness among school-aged children is associated with high absenteeism and dropout rates, thereby lowering educational achievements and ultimately earning potential. Bleakley and colleague's study found that a 10 % decrease in malaria incidence increased female educational attainment in Paraguay by 0.1 years, and literacy increased by one to two percentage points (Bleakley, 2003).

4. Policy analysis and recommendations

Combating malaria requires a multifaceted approach that addresses the disease as well as public health and economic considerations.

• 1.Strengthening Healthcare Systems: Synergizing health interventions with economic policies can further enhance the effects of both. Quality healthcare is essential and must be well funded. This includes educating health workers, providing a steady supply of antimalarial drugs, and improving diagnostic technologies (Onyinyechi et al., 2023). Raising awareness about malaria prevention and control is another potential economic benefit (Sicuri et al., 2022).
• 2.Preventive Measures: Further provision of preventive tools like insecticide-treated nets, in-door residue spray, and educating more people on how to prevent malaria will lead to a decline in the spread of malaria (Pryce et al., 2022).
• 3.Research and Development: There must be sustained funding for research and development to implement more useful malaria vaccines and remedies. Long-term malaria control strategies rely on advancements in vector control and disease management (Lobo et al., 2018).
• 4.Economic Support Programs: Providing social protection and economic support programs can assist families in mitigating the economic effects of malaria. These programs could encompass cash transfers, the expansion of microfinance opportunities, and assistance for impacted businesses (Rogers et al., 2024).
• 5.International Support and Collaboration: Only with assistance from other countries, particularly financial support from global health organizations and collaboration between developed and developing nations, can we maintain and improve malaria interventions. Development aid from other nations and contributions from organizations such as the WHO and the Global Fund may significantly assist countries in implementing malaria control efforts (Jezek, 2021).

5. Conclusion

Malaria continues to pose a significant economic burden on developing nations, particularly in sub-Saharan Africa, where its impact on economic growth, labour productivity, healthcare expenditure, and overall financial stability is profound. The findings of this study highlight that malaria significantly reduces GDP growth, hinders investment, disrupts the tourism sector, and weakens human capital development. Additionally, the disease exacerbates poverty and food insecurity by contributing to high absenteeism and reduced productivity, especially in the agricultural sector. The direct and indirect economic costs of malaria strain healthcare systems, increase household expenditures, and deepen financial instability among affected populations, thereby perpetuating poverty cycles. Despite these insights, this study has limitations. The reliance on existing literature may introduce biases related to data availability and methodological differences among studies. Additionally, variations in healthcare infrastructure, economic structures, and malaria intervention strategies across different countries may influence the generalizability of the findings. Future research should focus on country-specific economic assessments, long-term cost-effectiveness analyses of malaria control programs, and the impact of emerging technologies in malaria prevention and treatment. Addressing malaria's economic impact requires a multifaceted approach, including strengthened healthcare systems, improved prophylactic and therapeutic interventions, sustained investment in research and development, and international collaboration. By tackling both the health and economic consequences of malaria, developing nations can accelerate progress toward sustainable development and economic resilience.

Funding support

None.

CRediT authorship contribution statement

Kelechi Chinemerem Mezieobi: Writing – review & editing, Writing – original draft. Esther Ugo Alum: Writing – review & editing, Writing – original draft, Methodology, Conceptualization. Okechukwu Paul-Chima Ugwu: Writing – review & editing, Supervision. Daniel Ejim Uti: Writing – review & editing, Supervision, Conceptualization. Benedict Nnachi Alum: Writing – review & editing, Methodology. Simeon Ikechukwu Egba: Writing – review & editing, Visualization. Clinton Michael Ewah: Writing – review & editing, Validation, Resources.

Consent for publication

All Authors read and approved the manuscript for publication.

Ethics approval and consent to participate

Not applicable.

Declaration of competing interest

None.

Data availability

This study does not involve the generation or analysis of new data. All information discussed is derived from publicly available published sources, which are properly cited in the manuscript.