title: Effect of investment in malaria control on child mortality in sub-Saharan Africa in 2002-2008.
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.
  
  
  RESULTS
  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.
authors: Strategy, Performance and Evaluation Cluster, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
authors: Yoko
authors: Y
authors: Akachi
authors: Rifat
authors: R
authors: Atun
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D006801:Humans; D008288:Malaria / Q000191:economics* / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D012044:Regression Analysis