Agricultural extension, which takes the best information on technology, inputs and practices directly to farmers, may spread benefits beyond higher yields. In Uganda, a large-scale program also reduced malaria infections, particularly among pregnant women and children.

A team of MRR Innovation Lab researchers evaluated the impacts of a BRAC agricultural extension program in Uganda that trained women to promote improved seeds and basic farming knowledge & skills in their communities. Families in these communities used the additional income generated by increases in productivity to buy bednets, which reduced malaria infections.

“Most studies on malaria focus on health interventions like the free distribution of bednets,” said Yao Pan, the Aalto University economist who recently published these results. “The agricultural extension program’s effect on malaria infections is interesting because when policy makers want to weigh the costs and benefits of a program they normally ignore possible spill-over effects on other unintended outcomes.”

How Agricultural Extension Reduced Malaria Infections

Malaria, a disease transmitted by mosquito bites, remains a major health threat. According to the World Health Organization (WHO), there were an estimated 219 million cases of malaria in 87 countries in 2017. The WHO African Region is home to 92 percent of malaria infections and 93 percent of malaria deaths. Children under the age of 5 accounted for 61 percent of all malaria deaths worldwide.

“Some research has shown that when bednets are limited, it’s possible that working adults are prioritized to guarantee work on the farm,” said Pan. “When you relax this constraint, then more resources can be devoted toward children.”

Increasing agricultural productivity, not reducing malaria infections, was the purpose of the BRAC program in Uganda. Between 2008 and June 2011, the program reached almost 64,000 farmers. The MRR Innovation Lab analysis led by George Washington University economist Stephen Smith showed that the program generated significant improvements in income and food security.

Pan’s analysis showed that the improvements in income drove reductions in malaria infections. Communities eligible for the BRAC program had a lower prevalence of malaria by 8.9 percentage points compared to similar communities ineligible for the program. Children up to age 5 were 11.2 percentage points less likely to have had malaria in the prior six months. For pregnant women that figure was 22 percentage points.

“In general it helps the farm household to invest in health and other social aspects,” said Md. A. Saleque, the BRAC International advisor for Agriculture, Food Security and Livelihood. “We have not looked specially for reducing malaria but in general it has some positive effect on different social issues.”

Agricultural Extension and Health Policy

The Government of Uganda National Malaria Control Program (NMCP) has led a number of campaigns to increase the use of bednets as a means of reducing malaria infections. The most recent of these concluded in 2018, and the program’s newsletter from March of that year reported distribution to 38 million people.

“In all we are sure that this campaign will further help to bring the Malaria burden down,” wrote NMCP program manager Jimmy Opigo in the 2018 newsletter. “It is our hope that through this and other interventions, Malaria will be no more in Uganda.”

Direct malaria prevention by distributing bednets for free is very helpful, said Pan, and complements a long-term approach that maintains access to bednets without continued government spending. Families are less likely to replace bednets that wear out if they lack the income to buy them or local retailers no longer make them available.

“Something else needs to be done to keep people purchasing or replacing their old bednets, to encourage people to use them more and also to keep the bednet business profitable in the local market,” said Pan.

“Lifting people out of poverty, I think that is the best solution,” she added. “It complements direct malaria prevention in the long run.”