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. 2011;6(6):e21309.
doi: 10.1371/journal.pone.0021309. Epub 2011 Jun 30.

Effect of investment in malaria control on child mortality in sub-Saharan Africa in 2002-2008

Yoko Akachi  1 , Rifat Atun
Affiliations

Effect of investment in malaria control on child mortality in sub-Saharan Africa in 2002-2008

Yoko Akachi et al. PLoS One. 2011.

Abstract

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.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: RA is Director of Strategy, Performance and Evaluation Cluster, and YA is Technical Officer at the Global Fund to Fight AIDS, Tuberculosis and Malaria. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Input, Output, and Outcome for Malaria and Child Health: 34 Countries in Sub-Saharan Africa 2002–2008.
Figure 2
Figure 2. Accumulated Investment in Malaria and Lives Saved by ITN/IRS Coverage 2002–2008 Sub-Saharan Africa.
Figure 3
Figure 3. Lives Saved by ITN/IRS per 1 million children: Average ITN/IRS Coverage in 34 SSA countries 2002–2008.
Figure 4
Figure 4. Lives Saved by ITN/IRS per 1 million children: ITN/IRS Coverage Trend in 34 SSA Countries 2002–2008.
See this image and copyright information in PMC

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