Malaria affects student performance in HE entry exams

Exposure to malaria could be the reason for the declining levels of performance in secondary school exit exams in Tanzania, a study found. Students who do not take the exams could fail to meet tertiary education entry requirements and forfeit the chance to continue their studies in countries in Sub-Saharan Africa where the prevalence of the disease is relatively high.

Tejendra Pratap Singh, a PhD candidate at Georgia State University in the United States, recently discussed this issue at a conference on economic development in Africa that was held at the Centre for the Study of African Economies at the University of Oxford in the United Kingdom.

In the study, When it Stings: Malaria and student achievement, Singh examined the impact on academic achievement among Tanzania’s students sitting for the Certificate of Secondary Education Examination (CSEE) and the Advanced Certificate of Secondary Education Examination (ACSEE).

Both examinations are administered by the National Examinations Council of Tanzania (NECTA) and are used to determine a candidate's competence for further education and training, future career prospects, and eligibility to be selected for specific degree programmes at the universities.

Scores showed a correlation

According to Singh, the study is based on the proposition that exposure to vector-borne diseases could affect human capital formation in a country. He investigated the prevalence of malaria in Tanzania, a disease that is caused by Plasmodium falciparum, a parasite that causes severe illness and is commonly transmitted to humans through the bite of the female anopheles mosquito.

According to the World Health Organization (WHO), Africa “carries a disproportionately high share of the global malaria burden. In 2022, the region was home to 94% of malaria cases (233 million) and 95% (580,000) of malaria deaths. Children under five accounted for about 80% of all malaria deaths in the region.”

In fact, according to the WHO, young children and pregnant women in most countries in Sub-Saharan Africa are at high risk of contracting severe malaria.

Given this context, Singh wanted to establish whether students’ increasingly poor performance in the examinations could be the consequence of exposure to malaria. To find out, he analysed the NECTA’s database of student test scores in the two examinations for the 2016-19 period. The data showed in which centres the students wrote the exams, as well as the score they received for each exam they wrote.

The database, according to Singh, also showed whether a student was absent for a particular examination he or she had registered for. “Subsequently, after analysing all the information, I found that increased malaria exposure worsens student performance in the CSEE and ACSEE high-stakes examinations,” Singh said.

Eliminating malaria could increase grades

The issue of malaria impacting student learning outcomes is not new in the region. Two years ago, Dr Laia Cirera, a research and data specialist at the United Nations Children’s Fund (UNICEF), and her colleagues showed that, if malaria were to be eliminated in southern Mozambique, students would perform better in school.

Their study, ‘The Impact of a Malaria Elimination Initiative on School Outcomes: Evidence from Southern Mozambique’, that was published in Elsevier’s journal Economics and Human Biology, showed it was possible to reduce primary student school absenteeism by 28% as well as increase students’ grades by 2%. “Our findings provided evidence on the negative impact of malaria on primary education,” Cirera stated.

The latest study offers new insight into the impact of malaria in Tanzania and probably in other African countries that have a high prevalence of malaria affecting student performance in high-stakes secondary school exit examinations.

Failing the CSEE in Tanzania prevents a student from getting an opportunity to proceed to A-levels or joining diploma-awarding tertiary institutions, while failing the ACSEE automatically shuts the door for selection to join a university.

Female and older students at risk

Singh’s study showed student performance worsens when they are exposed to higher levels of malaria in the days preceding the examinations. He found that an increase of one percentage point in the malaria positivity rate negatively affects student performance by 0.088 standard deviations, Singh said.

The results of the study showed that the effect was more pronounced among older and female students, while there were also indicators that the effect was higher in reading subjects compared to mathematics.

In addition to the declining student performance, malaria exposure was found to increase the likelihood that students would miss the examinations for which they had enrolled. Students who miss or fail can only retake these examinations under special circumstances.

Exams taken during high-risk times

The study also considered how climatic conditions in Tanzania influenced student exposure to malaria, especially during the rainy seasons. While malaria in Tanzania persists throughout the year, the risk is higher during the rainfall seasons, an aspect that was used to explain the elevated exposure to malaria that affected student performance in the CSEE and ACSEE.

Explaining the ACSEE as an indicator, Singh found that the examination is taken in May, a time when temperatures, rainfall, and humidity vary. These are all factors conducive to mosquito breeding. According to the study, chances of contracting malaria were higher on days when the temperature was between 22°C and 28°C.

Studying the relationship between students’ standardised test scores and malaria positivity, Singh noted there were higher levels of malaria exposure in the days leading up to the examination month, which, he said, had a detrimental impact on student performance. He noted that, during that period, more students were hospitalised or stayed home due to malaria.

It is not certain why older and female students run a greater risk of contracting malaria. The study did not specify age. Although the study alluded to the fact that students living in relatively “unhealthy areas” were more likely to be exposed to malaria, there were no indicators of how the incidence of malaria could have been reduced among students through interventions such as insecticide-treated bed nets, indoor spraying and effective treatment with antimalarial drugs.

A related concern is that, as climate changes and gets warmer, it is expected an extra 4.7 billion people might be at risk of malaria or dengue fever by 2070 as the ‘epidemic belt’ of the diseases expands, a 2021 study reported in The Lancet found.

The study, therefore, shows that Sub-Saharan countries should be alert as to how the disease is affecting the formation of human capital in higher education.