title: Impact of Malaria Control on Mortality and Anemia among Tanzanian Children Less than Five Years of Age, 1999-2010.
abstract: BACKGROUND
  Mainland Tanzania scaled up multiple malaria control interventions between 1999 and 2010. We evaluated whether, and to what extent, reductions in all-cause under-five child mortality (U5CM) tracked with malaria control intensification during this period.
  
  
  METHODS
  Four nationally representative household surveys permitted trend analysis for malaria intervention coverage, severe anemia (hemoglobin <8 g/dL) prevalence (SAP) among children 6-59 months, and U5CM rates stratified by background characteristics, age, and malaria endemicity. Prevalence of contextual factors (e.g., vaccination, nutrition) likely to influence U5CM were also assessed. Population attributable risk percentage (PAR%) estimates for malaria interventions and contextual factors that changed over time were used to estimate magnitude of impact on U5CM.
  
  
  RESULTS
  Household ownership of insecticide-treated nets (ITNs) rose from near zero in 1999 to 64% (95% CI, 61.7-65.2) in 2010. Intermittent preventive treatment of malaria in pregnancy reached 26% (95% CI, 23.6-28.0) by 2010. Sulfadoxine-pyrimethamine replaced chloroquine in 2002 and artemisinin-based combination therapy was introduced in 2007. SAP among children 6-59 months declined 50% between 2005 (11.1%; 95% CI, 10.0-12.3%) and 2010 (5.5%; 95% CI, 4.7-6.4%) and U5CM declined by 45% between baseline (1995-9) and endpoint (2005-9), from 148 to 81 deaths/1000 live births, respectively. Mortality declined 55% among children 1-23 months of age in higher malaria endemicity areas. A large reduction in U5CM was attributable to ITNs (PAR% = 11) with other malaria interventions adding further gains. Multiple contextual factors also contributed to survival gains.
  
  
  CONCLUSIONS
  Marked declines in U5CM occurred in Tanzania between 1999 and 2010 with high impact from ITNs and ACTs. High-risk children (1-24 months of age in high malaria endemicity) experienced the greatest declines in mortality and SAP. Malaria control should remain a policy priority to sustain and further accelerate progress in child survival.
authors.affiliation: Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.
authors.forename: Paul
authors.initials: P
authors.lastname: Smithson
authors.affiliation: ICF International, Rockville, Maryland, United States of America.
authors.forename: Lia
authors.initials: L
authors.lastname: Florey
authors.affiliation: United States Agency for International Development, U.S. President's Malaria Initiative, Washington, DC, United States of America.
authors.forename: S Rene
authors.initials: SR
authors.lastname: Salgado
authors.affiliation: United States Agency for International Development, U.S. President's Malaria Initiative, Washington, DC, United States of America.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Hershey
authors.affiliation: Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.
authors.forename: Honorati
authors.initials: H
authors.lastname: Masanja
authors.affiliation: Centers for Disease Control and Prevention, U.S. President's Malaria Initiative, Atlanta, Georgia, United States of America.
authors.forename: Achuyt
authors.initials: A
authors.lastname: Bhattarai
authors.affiliation: National Malaria Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania.
authors.forename: Alex
authors.initials: A
authors.lastname: Mwita
authors.affiliation: Centers for Disease Control and Prevention, U.S. President's Malaria Initiative, Atlanta, Georgia, United States of America.
authors.forename: Peter D
authors.initials: PD
authors.lastname: McElroy
mesh_terms: D000740:Anemia / Q000517:prevention & control*; D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000453:epidemiology* / Q000401:mortality* / Q000517:prevention & control; D008297:Male; D009032:Mosquito Control / Q000379:methods*; D011247:Pregnancy; D015995:Prevalence; D015996:Survival Rate; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000962:Antimalarials