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EFFECT OF INVESTMENT IN MALARIA CONTROL ON CHILD MORTALITY IN SUB-SAHARAN AFRICA

Tuesday, 13th of September 2011

• EFFECT OF INVESTMENT IN MALARIA CONTROL ON CHILD MORTALITY IN SUB-SAHARAN AFRICA

PLoS One. 2011; 6(6): e21309. ‘ITN/IRS scale-up can be more efficiently prioritized to countries where malaria is a major cause of child deaths to save greater number of lives with available resources.’  Full text, with tables, is at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127861/?tool=pubmed Published online 2011 June 30. doi:  10.1371/journal.pone.0021309

PMCID: PMC3127861

 

Effect of Investment in Malaria Control on Child Mortality in Sub-Saharan Africa in 2002–2008

Yoko Akachi1 and Rifat Atun1,2*

1Strategy, Performance and Evaluation Cluster, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland

2Imperial College Business School, Imperial College, London, United Kingdom

Abdisalan Mohamed Noor, Editor

Kenya Medical Research Institute - Wellcome Trust Research Programme, Kenya

* E-mail: r.atun@imperial.ac.uk

Analyzed the data: YA RA. Wrote the paper: YA RA. RA conceived the study. YA led the design of the study, gathering of data, collation, preparation, analysis, interpretation of the data and wrote the first draft of the paper with guidance from RA. RA conceptualized the paper, contributed significantly to writing, and guided its development and completion. Both authors reviewed and approved the final paper.

Received November 29, 2010; Accepted May 30, 2011.

Background

Around 8.8 million children under-five die each year, mostly due to infectious diseases, including malaria that accounts for 16% of deaths in Africa, but the impact of international financing of malaria control on under-five mortality in sub-Saharan Africa has not been examined.

Methods and Findings

We combined multiple data sources and used panel data regression analysis to study the relationship among investment, service delivery/intervention coverage, and impact on child health by observing changes in 34 sub-Saharan African countries over 2002–2008. We used Lives Saved Tool to estimate the number of lives saved from coverage increase of insecticide-treated nets (ITNs)/indoor residual spraying (IRS). As an indicator of outcome, we also used under-five mortality rate. Global Fund investments comprised more than 70% of the Official Development Assistance (ODA) for malaria control in 34 countries. Each $1 million ODA for malaria enabled distribution of 50,478 ITNs [95%CI: 37,774–63,182] in the disbursement year. 1,000 additional ITNs distributed saved 0.625 lives [95%CI: 0.369–0.881]. Cumulatively Global Fund investments that increased ITN/IRS coverage in 2002–2008 prevented an estimated 240,000 deaths. Countries with higher malaria burden received less ODA disbursement per person-at-risk compared to lower-burden countries ($3.90 vs. $7.05). Increased ITN/IRS coverage in high-burden countries led to 3,575 lives saved per 1 million children, as compared with 914 lives in lower-burden countries. Impact of ITN/IRS coverage on under-five mortality was significant among major child health interventions such as immunisation showing that 10% increase in households with ITN/IRS would reduce 1.5 [95%CI: 0.3–2.8] child deaths per 1000 live births.

Conclusions

Along with other key child survival interventions, increased ITNs/IRS coverage has significantly contributed to child mortality reduction since 2002. ITN/IRS scale-up can be more efficiently prioritized to countries where malaria is a major cause of child deaths to save greater number of lives with available resources.