IMPACT OF MALARIA ON LABOUR PRODUCTIVITY IN NIGERIA 
CHAPTER ONE
INTRODUCTION
Background of the study
 In Nigeria, malaria is the number one public health problem (Onwujekwe, Malikel, Mustafa&Mnzavaa, 2000) and it is responsible for about 300,000 deaths every year (Coker&Chakraborty,2001). Malaria remains a major threat to public health despite decades of control efforts. It is a devastating disease that threatens labour productivity and economy of endemic countries. Malaria constitutes 10% of African's overall disease burden, accounting for 40% of public health expenditure, 30-50% of in-patient hospital admissions and up to 50% of out-patient visits in areas with high transmission (WHO, 2006).
A healthy workforce is one of our most important economic assets of a nation. According to Lilliard and Weiss (1997:16) "Health is one of the most important assets human being has; it permits us to fully develop our capacities". If this asset erodes or it is not developed completely, it can cause physical and emotional weakening, causing obstacles in the lives of people.
Despite various declarations by African governments in the 1990s and complementary effort promised in the main content of the Roll back Malaria Declaration in Abuja in 2000,malaria remains a major health challenge. About 107 countries and territories involving about 3.2 billion people are still at risk of malaria attack as at 2004 (WHO, 2005). Present estimates suggest that around 350 to 500 million clinical disease episodes occur annually (Bawah&Binka, 2005). Around 60% of clinical cases and over 80% of the deaths due to malaria occur in sub-Sahara Africa (Alaba, 2005). The above has serious implication foreconomic growth and welfare. The seemingly intractable trend of this ancient scourge has compounded the national and household poverty due to intensive loss of productive time to attack and death.
Given that malaria is endemic throughout Nigeria, and that more than half of the country's population is living below poverty line, malaria incidence may increase significantly in Nigeria because many may not be able to afford the newly introduced expensive drugs that are artemisinin-based treatment due to poverty. This has serious implications for the achievement of development blueprints. Effective control of malaria is capable of reducing household poverty, improvement in health outcomes, human capital development, welfare and aggregate national development in Nigeria.
According to Aghion, Howitt and Murtin (2010), there is a positive relationship between good health and productivity of skilled and unskilled labour.In addition to this, malaria imposes substantial socio-economic costs on both individuals and governments. For instance, the costs of malaria to individuals and their families include purchase of drugs for treating malaria at home, expenses for travel to, and treatment at dispensaries and clinics, lost days of work, absence from school, expenses for preventive measures, expenses for burial in case of deaths. As put by  World Health Organization (2010), there are still over 200 million cases of malaria and approximately one million deaths annually. On the other hand, the costs to governments include maintenance, supply and staffing of health facilities, purchase of drugs and supplies, public health interventions against malaria, such as insecticide spraying or distribution of insecticide-treated bed nets, lost days of work with resulting loss of income, loss of labour productivity and lost opportunities for joint economic ventures and tourism (WHO, 2011). The above facts have serious socio-economic implications on health outcome and welfare with indirect impact on economic growth. Malaria is responsible for an estimated average annual reduction of 13% in economic growth for those countries with the highest burden, Nigeria inclusive (Ojewumi&Ojewumi, 2012).
Good health as related to labour output or better production organization (since people of good health generally have better intellectual capacities), can enhance farmer's/household income and economic growth. Health affects productive systems by affecting the health of the producers. Poor health will result in loss of work days or decrease worker capacity, decrease innovation ability and ability to explore diverse production techniques.Approximately 50% of the Nigerian population experience at least one episode of malaria attack per year. However, official estimate suggests as much as four bouts of Malaria attack per person per year on the average (WHO, 2012).Malaria morbidity and mortality rate vary from region to region in Sub- Sahara Africa. Over the last century, valiant efforts were made to control malaria using tools such as anti-malaria drugs and insecticides. However, these efforts met with failure as the maintenance of control programs waned, as logistics and behavioural factors limited the effective use of preventions and also as the malaria parasites, Plasmodium falciparum developed resistant to first line anti-malaria drugsand Malaria Prevalence soared (Egbuche, 2013).
1.2Statementofthe Research Problem
Diseases, poor health and Low income are highly and positively correlated in both developed and developing countries including Nigeria. They represent a great burden to affected individuals. Although it is not easily quantified, the resulting welfare losses to the severely sick person can be significant, particularly in under developed regions with few or scarce health facilities. In developing regions with limited social security provision and healthcare facilities, individuals suffering from illness may grow weak, unable to work or study and generally unable to provide for their children and other dependents. This can have a significant adverse effect on household income. On a more aggregated level, however, it seems likely that a high disease burden may have a devastating negative effect on a country's productivity.
Diseases including malaria do not only constitute a public health problem but equally a social problem affecting individuals, families and the entire economy. It affects the human capital development as well as labour productivity of those affected thereby leading to poverty.Malaria has a significant effect on human capital accumulation, and decreases economic growth. Furthermore, malaria has a higher negative impact on vulnerable groups. Pregnant women and children under five are the most vulnerable. Malaria has a direct impact on household's income, wealth, labour productivity and labour market participation of both the sick as well as their care-givers. This translates into negative implication for labour productivity and hence leads to poverty (Castro &Mokate, 1988).
Incidence of tropical diseases such as malaria and schistosomiasis have both significant negative effects on indicators of development. There is however strong evidence that malaria is the deadliest of all tropical diseases. Equally, malaria is seen to be a major obstacle to African economic development. It affects welfare and growth in the following ways: it retards investment by discouraging tourism and international groups from setting up their firms in malaria endemic zones.
Burntland(1989) cited in WHO(2000) points out that malaria is hurting the living standards of Africans, Nigerians inclusive, and it is also preventing the improvement of living standards for future generations. Thus, the disease, with its impact on falling educational outcomes, and the deepening of poverty levels seriously affects future generations. In contemporary Africa, malaria is understood to be a disease of poverty and a consequence of poverty. The disease which is ravaging lives across the continent has significant measurable direct and indirect costs and has recently been shown to be a major constraint to economic development at micro and macro levels. For developing economies, this has meant that the gap in prosperity between countries with malaria and countries without malaria has become wider every single year (Alaba,2005).Malaria kills more than 500million people a year. In SSA, it causes more than 1 million deaths in infants and children less under- five. Well over 3000 children die because of this disease in SSA every day while in Nigeria malaria account for over 300,000 deaths per year (Onwujekwe, Mustafa &Mnzavaa, 2006).
Poverty, lack of adequate medical facilities, inadequate education are a few of the complex factors that facilitate the spread of the disease which is undermining the hard - won economic and social gains that many African countries were unable to achieve in the last decade (World Bank, 2000&2009).Among other Sub -Saharan African countries, Nigeria is well known for the high prevalence rate of malaria which is a leading cause of morbidity and mortality in the country (WHO, 2010).
Malaria continues to be a public health challenge in Sub-Saharan Africa and is further compoundedby poverty. This in turn is one of the determining factors of the malaria epidemic.
Malaria also has an effect on the working population. In adults recurrent bouts of fever (malaria) causes lower labour productivity. The transmission period of malaria coincides with the planting season, thus further lowering agricultural productivity. Lower productivity contributes to lower economic growth and the poverty levels, depth and severity that characterize most endemic Sub-Saharan African countries (Egbuche,2013).For instance, in 2012,malaria incidence was 6115308 while the number of death was 570.2 (Malaria fact sheet,2014).Malaria kills millions of lives in Sub -Saharan Africa daily with the most affected of the population being women and children (Malaria fact sheet,2014).
The direct costs of malaria include a combination of personal and public expenditures on both prevention and treatment of the disease. Personal or public spending to prevent or treat malaria contributes to poverty at the individual's economy level and the resulting national economy. Poverty equally leads to poor health, low levels of education and a fall in productivity. Poor health may come as a result of undiagnosed and poorly treated episodes of the malaria illness. Poverty however, stands out as a major problem in households, communities and most nations in Sub Saharan Africa including Nigeria. The 70% poverty level  plaguing Nigeria today can be attributed to many factors which affect the socio economic status of the country among which is malaria and hence a drop in labour productivity. It demobilizes the economically active population from endemic zonesthrough substitution of man- hour loss to incapacitation during malaria attacks and partial inactivity during debilitating periods (Alaba&Alaba, 2005;Andrew& Friedman,2014).
It has equally been found that in Nigeria malaria affects pregnant women leading to a loss in household income of about $12 to $25 per week (WHO,2014). However, studies on this area are scanty in Nigeria. It is for this reason that a study relating malaria and labour productivity in Nigeriabecomes relatively important.
Significant efforts have been directed at solving malaria problems in Nigeria both at the medical, social and economic front. However, the magnitude of the malaria scourge seemingly keeps increasing. Also, there has been dearth of empirical research aimed at addressing the incidence of the disease on labour productivity. Malaria therefore serves as leveragetowards poverty which can in turn lead to devastating effects on labour productivity. It is on this backdrop that an empirical examination of malaria and labour productivity in Nigeria will be undertaken to ascertain the gravity of its impact on households in the country.
1.3       Objectives of the Study
The overall objective of this study is to investigate the extent to which malaria prevalence affects labour productivity in Nigeria.
Specifically, the study intends to examine the impact of
Malaria on labour productivity in Nigeria.
Physical capital on labour productivity in Nigeria.
Labour forceonlabour productivity in Nigeria.
Government expenditure on health on labour productivity in Nigeria.
Life expectancy rate on labour productivity in Nigeria.
1.4     Hypotheses of the Study
The null hypotheses investigated in this study are:
H0:   Malaria prevalence does not have a significant impact on labour productivity in Nigeria.
Ho:  Physical capitaldoes not have a significant impact on labour productivity in Nigeria.
H0:   Labour force does not have a significant impact on labour productivity in Nigeria.
H0:  Government expenditureon health does not have a significant impact on labour productivity in Nigeria.
H0:  Life expectancy rate does not have a significant impact on labour productivity in Nigeria.
1.5     Justification of the Study
The implications of malaria for welfare and development has been of great concern across countries in Africa especially Nigeria. However, the determination of actual earnings which is a theoretical measure of productivity varies across different economic sectors and remains deficient.
It is very important to attempt an understanding of the mechanism through which malaria affects households be it through income, labour productivity, time spent in caring for the sick and/or household expenditure. Using household survey of 3 developing countries, King and Yan Wang (1993), emphasized the relevance of this kind of study. The World Health Organization (2000) reported that malaria directly or indirectly causes close to 2 million deaths a year, a majority of whom are children between the ages of 0 to 5 and leaves them with severe neurological problems and learning disabilities" (World Bank, 2001). Equally in 2002, about 58 out of every 1000 deaths in African countries were caused by malaria (WHO, 2002).The socio-economic impact of malaria in Nigeria is tremendous. It is estimated that malaria-related economic loss represents at least 1.3% of GNP per annum in malaria-endemic area (Gallup&Sachs, 2003).Though there have been different assertions by scholars such as Gallup and Sachs (2003)that diseases such as malaria have a negative impact on productivity.
Their study reveals that, enormous economic losses occur due to recurrent malaria attacks as such new policy decisions are to be made. Studies in Nigeria have revealed that large sums of money are spent annually on malaria medication and that a disproportionate part of the financial burden falls on households(World Bank,2005).Never the less such studies such as Alaba and Alaba (2005)concentrate on the effect of malaria on pregnant women and children, neglecting the impact of this disease on productivity. The World Bank estimates that Nigeria accounts for 20% of World malaria cases. Meanwhile, in Cote d'lvoire, Ghana and Mauritania, the cost of a single period of malaria on an individual is estimated at 11% of normal monthly earnings but in Nigeria, it is up to 13%(Alaba&Alaba,2005).
Previous studies however based their findings on qualitative techniques of analysis by making use of the idea of Focus Group Discussions. For example, Hong (2007) using data from the U.S federal census records noted that the subsequent increased exposure to malaria infections significantly reduced the labour productivity of immigrants. In the context of Nigeria alone, a country approximately 170 million people, malaria is the leading disease reported over the past years with 51% of people reporting illness due to malaria (Nigeria living standard survey, 2010).
Developing countries however face much more crippling burden than developed countries, especially regarding infectious diseases such as malaria, HIV/AIDS. Every year about thousandsof children die due to malaria and poverty in Cameroon.
According to the WorldBank, household survey conducted in 2012, 70% of the Nigerian population lives below the poverty line. Poverty reduction involves using the principal asset (human capital) of the poor which largely represent their health and strength. Malaria, AIDS and Tuberculosis constitute a serious threat to Nigeria's human capital. These diseases swallow up the meager resources of the underprivileged, shutting them up in the vicious cycle of poverty which therefore reflects the slow economic growth of the nation. Malaria contributed to poverty by lowering individual productivity (26% of total absenteeism from work is attributed to malaria) and consumes up to 40% of households' health budget. Evidences show that such assertions were not tested. This might have been due to lack of data and adequate resources (Weisbrod, 1986; Gallup & Sachs,2003; WHO,2014). Generally, little research has been done on health issues especially on the relationship between the  malaria prevalence on labour productivity in Nigeria. This study therefore tries to study the impact of malaria prevalence on labour productivity in Nigeria by applying quantitative techniques of analysis.
1.6       Organization of the Study
The rest of the thesis is organized as follows. Chapter two is devoted to the conceptual framework of the study, definition of some terms as used in the study, examines the burden of the disease globally, review of relevant literature and discusses theoretical and empirical issues relating to the incidence of malaria on labour productivity. The theoretical framework, methodology and the model used in the study are presented in Chapter three. This chapter equally looks at the data source as well as the analytical technique used to achieve the objectives of the study. Chapter four contains the findings of the study while the last chapter, chapter five presents the summary of findings, discusses possible implications for policy, conclusion and recommendation.
1.7 Scope of the Study
The scope of this study will be limited to the impact of malaria on labour productivity in Nigeria. The study will cover a period of thirty three (33) years spanning from 1981 through 2014. This period under study covers the period of the first emergence of malaria in Nigeria till 2014. The choice of the period is informed by availability of data which will be gleamed from the bulletin of the Central Bank of Nigeria (CBN) and World Development Indicator (WDI).