title: Assessing the Contribution of Malaria Vector Control and Other Maternal and Child Health Interventions in Reducing All-Cause Under-Five Mortality in Zambia, 1990-2010.
abstract: Under-five mortality in Zambia has declined since 1990, with reductions accelerating after 2000. Zambia's scale-up of malaria control is viewed as the driver of these gains, but past studies have not fully accounted for other potential factors. This study sought to systematically evaluate the impact of malaria vector control on under-five mortality. Using a mixed-effects regression model, we quantified the relationship between malaria vector control, other priority health interventions, and socioeconomic indicators and district-level under-five mortality trends from 1990 to 2010. We then conducted counterfactual analyses to estimate under-five mortality in the absence of scaling up malaria vector control. Throughout Zambia, increased malaria vector control coverage coincided with scaling up three other interventions: the pentavalent vaccine, exclusive breast-feeding, and prevention of mother-to-child transmission of HIV services. This simultaneous scale-up made statistically isolating intervention-specific impact infeasible. Instead, in combination, these interventions jointly accelerated declines in under-five mortality by 11% between 2000 and 2010. Zambia's scale-up of multiple interventions is notable, yet our findings highlight challenges in quantifying program-specific impact without better health data and information systems. As countries aim to further improve health outcomes, there is even greater need-and opportunity-to strengthen routine data systems and to develop more rigorous evaluation strategies.
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.
authors.forename: Marie
authors.initials: M
authors.lastname: Ng
authors.affiliation: University of California, Berkeley, Berkeley, California.
authors.forename: K
authors.initials: K
authors.lastname: Ellicott Colson
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.
authors.forename: Nancy
authors.initials: N
authors.lastname: Fullman
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.
authors.forename: Laura
authors.initials: L
authors.lastname: Dwyer-Lindgren
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.
authors.forename: Tom
authors.initials: T
authors.lastname: Achoki
authors.affiliation: United States Agency for International Development, Washington, District of Columbia.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Schneider
authors.affiliation: Clinton Health Access Initiative, Lusaka, Zambia.
authors.forename: Peter
authors.initials: P
authors.lastname: Mulenga
authors.affiliation: Department of Economics, University of Bergen, Bergen, Norway.|School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.
authors.forename: Peter
authors.initials: P
authors.lastname: Hangoma
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.|School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.
authors.forename: Felix
authors.initials: F
authors.lastname: Masiye
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.
authors.forename: Emmanuela
authors.initials: E
authors.lastname: Gakidou
mesh_terms: D002423:Cause of Death; D000067576:Child Health; D046688:Child Mortality; D002675:Child, Preschool; D062489:Health Impact Assessment; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D057148:Insecticide-Treated Bednets; D007306:Insecticides / Q000627:therapeutic use*; D008288:Malaria / Q000401:mortality / Q000517:prevention & control* / Q000635:transmission; D000068097:Maternal Health; D015233:Models, Statistical; D009032:Mosquito Control / Q000379:methods*; D000072138:Mosquito Vectors; D012959:Socioeconomic Factors; D015024:Zambia
chemical_list: D007306:Insecticides