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. 2017 Sep;97(3_Suppl):9-19.
doi: 10.4269/ajtmh.15-0363.

Framework for Evaluating the Health Impact of the Scale-Up of Malaria Control Interventions on All-Cause Child Mortality in Sub-Saharan Africa

Yazoume Yé  1 , Thomas P Eisele  2 , Erin Eckert  3 , Eline Korenromp  4   5 , Jui A Shah  1 , Christine L Hershey  3 , Elizabeth Ivanovich  6 , Holly Newby  7 , Liliana Carvajal-Velez  8 , Michael Lynch  9 , Ryuichi Komatsu  10 , Richard E Cibulskis  11 , Zhuzhi Moore  12 , Achuyt Bhattarai  9
Affiliations

Framework for Evaluating the Health Impact of the Scale-Up of Malaria Control Interventions on All-Cause Child Mortality in Sub-Saharan Africa

Yazoume Yé et al. Am J Trop Med Hyg. 2017 Sep.

Abstract

Concerted efforts from national and international partners have scaled up malaria control interventions, including insecticide-treated nets, indoor residual spraying, diagnostics, prompt and effective treatment of malaria cases, and intermittent preventive treatment during pregnancy in sub-Saharan Africa (SSA). This scale-up warrants an assessment of its health impact to guide future efforts and investments; however, measuring malaria-specific mortality and the overall impact of malaria control interventions remains challenging. In 2007, Roll Back Malaria's Monitoring and Evaluation Reference Group proposed a theoretical framework for evaluating the impact of full-coverage malaria control interventions on morbidity and mortality in high-burden SSA countries. Recently, several evaluations have contributed new ideas and lessons to strengthen this plausibility design. This paper harnesses that new evaluation experience to expand the framework, with additional features, such as stratification, to examine subgroups most likely to experience improvement if control programs are working; the use of a national platform framework; and analysis of complete birth histories from national household surveys. The refined framework has shown that, despite persisting data challenges, combining multiple sources of data, considering potential contributions from both fundamental and proximate contextual factors, and conducting subnational analyses allows identification of the plausible contributions of malaria control interventions on malaria morbidity and mortality.

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Figures

Figure 1.
Figure 1.
Plausibility study design framework for assessing malaria control intervention impact on malaria morbidity and all-cause child mortality. ANC = antenatal care; EIR = entomological inoculation rate; EPI = extended program for immunization; ITN = insecticide-treated net; IRS = indoor residual spraying; IPTp = intermittent preventive treatment; GDP = gross domestic product; MCM = malaria case management; Vit = vitamin; PMTCT = prevention of mother to child transmission. This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
Example evaluation timeframe, from Evaluation of the Impact of Malaria Control Interventions on All-Cause Mortality in Children Under-Five in Uganda. Source: Unpublished report). DHS = Demographic and Health Surveys; MIS = Malaria Indicator Survey; ACT = artemisinin-based combination therapies; LLIN = long-lasting insecticidal nets; IPTp = intermittent preventive treatment of pregnant women.
Figure 3.
Figure 3.
Three analytical plans for validating results from primary analysis.
See this image and copyright information in PMC

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