Appendix 3, page 160 contained an error. “The outcome of this program was that reported malaria cases dropped by 60 percent, from 557,787 in 1989 to 221,600 in 1996.”
The data source for this statement (Akhavan et al., 1996) says on page 1390 that “For 1996, only half the cases treated or estimated to have been prevented are counted, because the project ended in June of that year and the calculation of costs runs through only half the year”.
The correct text is as follows.
Malaria transmission was controlled elsewhere in Brazil by 1980, but in the Amazon Basin cases increased steadily until 1989, to almost half a million a year and the coefficient of mortality quadrupled in 1977-1988. A World Bank project supported the program from late 1989 to mid-1996, and in 1992-1993, with advice from the Pan American Health Organization, facilitated a change toward earlier and more aggressive case treatment and more concentrated vector control. The epidemic stopped expanding in 1990-1991 and reversed in 1992-1996. The effect of this change was to reduce incidence much below the level it would have reached, preventing an estimated 1.73 million cases. The result of fewer cases and lower fatality from those cases that did occur was to avert an estimated 231,000 deaths over the 7-1/2 years of the program. Converting the savings in lives and in morbidity into Disability-Adjusted Life Years (DALYs) yields almost nine million DALYs, 5.1 million from treatment and 3.9 million from prevention. Nearly all the gain came from controlling deaths and therefore from controlling falciparum.
[Source: Akhavan, D., Musgrove, P., Abrantes, A., Gusmao, R. “Cost-effective malaria control in Brazil: Cost-effectiveness of a Malaria Control Program in the Amazon Basin of Brazil, 1998-1996.” Social Science & Medicine 49 (1999) 1385-1399.