Impact of a malaria-control project in Benin that included the integrated management of childhood illness strategy

Abstract

Objectives: To estimate the impact of the Integrated Management of Childhood Illness (IMCI) strategy on early-childhood mortality, we evaluated a malaria-control project in Benin that implemented IMCI and promoted insecticide-treated nets (ITNs).

Methods: We conducted a before-and-after intervention study that included a nonrandomized comparison group. We used the preceding birth technique to measure early-childhood mortality (risk of dying before age 30 months), and we used health facility surveys and household surveys to measure process indicators.

Results: Most process indicators improved in the area covered by the intervention. Notably, because ITNs were also promoted in the comparison area children's ITN use increased by about 20 percentage points in both areas. Regarding early-childhood mortality, the trend from baseline (1999-2001) to follow-up (2002-2004) for the intervention area (13.0% decrease; P < .001) was 14.1% (P < .001) lower than was the trend for the comparison area (1.3% increase; P = .46).

Conclusions: Mortality decreased in the intervention area after IMCI and ITN promotion. ITN use increased similarly in both study areas, so the mortality impact of ITNs in the 2 areas might have canceled each other out. Thus, the mortality reduction could have been primarily attributable to IMCI's effect on health care quality and care-seeking.

FIGURE 1

Logic model for the evaluation of a malaria-control project: Benin, 1999–2006. Note. IMCI = Integrated Management of Childhood Illness strategy; ITN = insecticide-treated net. ^aHealth-worker supports included supervision, job aids, and nonfinancial incentives. Conceptually, such supports are a facet of the health-systems component of IMCI. ^bConceptually, a facet of the community component of IMCI. ^cIncludes antimalarial drug resistance, births at health facilities, birth spacing, breastfeeding, child vaccinations, HIV prevalence, insecticide resistance, improved water sources, rainfall (a climatic determinant of disease transmission), socioeconomic status (electricity in household, education), tetanus vaccination for women, and vitamin A supplementation.

FIGURE 2

Time line of implementation and evaluation activities of a malaria-control project: Benin, 1999–2006. Note. IMCI = Integrated Management of Childhood Illness strategy; ITN = insecticide-treated net. ^aScale-up increases progressively over time; arrows indicate that support for activities continued after initial scale-up. ^bThe Demographic and Health Surveys are national household surveys not conducted by project staff. Results of the Demographic and Health Surveys and the mortality monitoring were available for intervention and comparison areas. ^cResults of the preceding birth technique in the study area reflected the early-childhood mortality risk centered at a time about 2 years in the past, indicated by the diagonal arrow; dashed vertical lines indicate the approximate time to which each 12-month block of data applies.