title: Assessment of Malawi's success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation.
abstract: BACKGROUND
  Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies.
  
  
  METHODS
  We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007-2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013.
  
  
  RESULTS
  The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991-1995 to 119 deaths (95% CI 105 to 132) in the period 2006-2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide-treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses.
  
  
  CONCLUSIONS
  Malawi provides a strong example for countries in sub-Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community-based delivery platform, can lead to significant reductions in child mortality.
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa ; School of Public Health, University of the Western Cape, Cape Town, South Africa ; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Wanga
authors.initials: W
authors.lastname: Zembe
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Nobubelo
authors.initials: N
authors.lastname: Ngandu
authors.affiliation: Saving Newborn Lives/Save the Children, Cape Town, South Africa.
authors.forename: Mary
authors.initials: M
authors.lastname: Kinney
authors.affiliation: Biostatistics Research Unit, South African Medical Research Council, Pretoria, South Africa ; School of Mathematics, Statistics and Computer Science, University of Kwazulu-Natal, Durban, South Africa.
authors.forename: Samuel
authors.initials: S
authors.lastname: Manda
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Donela
authors.initials: D
authors.lastname: Besada
authors.affiliation: School of Public Health, University of the Western Cape, Cape Town, South Africa ; UNICEF, United Nations Plaza, New York, NY, USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Daniels
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rohde
authors.affiliation: School of Public Health, University of the Western Cape, Cape Town, South Africa ; Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: van Damme
authors.affiliation: Saving Newborn Lives/Save the Children, Cape Town, South Africa.
authors.forename: Kate
authors.initials: K
authors.lastname: Kerber
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Daviaud
authors.affiliation: Centre for Global Health Research and Global Health Academy, University of Edinburgh Medical School, Edinburgh, Scotland, UK.
authors.forename: Igor
authors.initials: I
authors.lastname: Rudan
authors.affiliation: UNICEF, United Nations Plaza, New York, NY, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Muniz
authors.affiliation: UNICEF, United Nations Plaza, New York, NY, USA.
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Oliphant
authors.affiliation: UNICEF, Lilongwe, Malawi.
authors.forename: Texas
authors.initials: T
authors.lastname: Zamasiya
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa ; School of Public Health, University of the Western Cape, Cape Town, South Africa.
authors.forename: Jon
authors.initials: J
authors.lastname: Rohde
authors.affiliation: School of Public Health, University of the Western Cape, Cape Town, South Africa ; School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data; D008295:Malawi; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011247:Pregnancy; D015397:Program Evaluation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D022242:Pneumococcal Vaccines