title: Child mortality patterns in rural Tanzania: an observational study on the impact of malaria control interventions.
abstract: BACKGROUND
  Between 1997 and 2009, a number of key malaria control interventions were implemented in the Kilombero and Ulanga Districts in south central Tanzania to increase insecticide-treated nets (ITN) coverage and improve access to effective malaria treatment. In this study we estimated the contribution of these interventions to observed decreases in child mortality.
  
  
  METHODS
  The local Health and Demographic Surveillance Site (HDSS) provided monthly estimates of child mortality rates (age 1 to 5 years) expressed as cases per 1000 person-years (c/1000py) between 1997 and 2009. We conducted a time series analysis of child mortality rates and explored the contribution of rainfall and household food security. We used Poisson regression with linear and segmented effects to explore the impact of malaria control interventions on mortality.
  
  
  RESULTS
  Child mortality rates decreased by 42.5% from 14.6 c/1000py in 1997 to 8.4 c/1000py in 2009. Analyses revealed the complexity of child mortality patterns and a strong association with rainfall and food security. All malaria control interventions were associated with decreases in child mortality, accounting for the effect of rainfall and food security.
  
  
  CONCLUSIONS
  Reaching the fourth Millenium Development Goal will require the contribution of many health interventions, as well as more general improvements in socio-environmental and nutritional conditions. Distinguishing between the effects of these multiple factors is difficult and represents a major challenge in assessing the effect of routine interventions. However, this study suggests that credible estimates can be obtained when high-quality data on the most important factors are available over a sufficiently long time period.
authors.affiliation: Royal Tropical Institute (KIT), KIT Biomedical Research, Amsterdam, The Netherlands, Ifakara Health Institute, Dar es Salaam, Tanzania, Novartis Foundation for Sustainable Development, Basel, Switzerland, Tanzania Commission for Science and Technology, Dar es Salaam, Tanzania, Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Switzerland and Faculty of Science, University of Basel, Basel, Switzerland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Alba
authors.forename: Rose
authors.initials: R
authors.lastname: Nathan
authors.forename: Alexander
authors.initials: A
authors.lastname: Schulze
authors.forename: Hassan
authors.initials: H
authors.lastname: Mshinda
authors.forename: Christian
authors.initials: C
authors.lastname: Lengeler
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage*; D002648:Child; D046688:Child Mortality; D005260:Female; D005523:Food Supply; D006297:Health Services Accessibility; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D009032:Mosquito Control / Q000379:methods*; D009752:Nutritional Status; D012424:Rural Population / Q000706:statistics & numerical data*; D012621:Seasons; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology
chemical_list: D000962:Antimalarials
keywords: Malaria; child mortality; food security; malaria control interventions; mortality impact; rainfall