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President's Malaria Initiative reduced deaths of children younger than 5 years
The United States President’s Malaria Initiative — a program aimed at promoting malaria interventions including the use of insecticide-treated nets, rapid diagnostic tests and artemisinin-based combination therapy — may have significantly reduced death in children younger than 5 years in sub-Saharan Africa.
“Understanding the role global policies and funding played in reducing malaria mortality, including changes in health behaviors, can be valuable as countries and global donors work toward the Sustainable Development Goals, including the goal of eradicating malaria by 2030,” Aleksandra Jakubowski, PhD, MPH, from the department of health policy and management and Gillings School of Global Public Health at the University of North Carolina, and colleagues wrote.
The researchers also stress that there is uncertainty regarding the amount of future funding and donations toward health aid because they have stagnated since 2010. Additionally, this type of external funding “remains a significant source of total health expenditures in low-income countries.”
To assess the connection between child mortality rates in sub-Saharan Africa and the President’s Malaria Initiative (PMI), the researchers conducted a difference-in-differences analysis in which the trends in mortality rates for children younger than 5 years and the prevalence of malaria interventions were compared in 19 countries that received PMI assistance and 13 that did not. Data from 1995 to 2014 were included in the analysis and were controlled for factors such as presence or intensity of other funding sources, individual and household characteristics and year fixed effects.
A significant annual decrease in childhood mortality was observed when PMI was implemented (adjusted RR 0.84%, 95% CI 0.74-0.96), with each per-capita expenditure dollar contributing to fewer deaths (aRR 0.86, 95% CI 0.78-0.93). The researchers estimated that the percentage of childhood deaths decreased from 28.9 to 24.3 per 1,000 person-years.
The amount of the population in included countries that used nets treated with insecticide rose 8.34% (95% CI 0.86-15.83). A notable increase was also observed in indoor residual spraying after implementation (6.63%, 95% CI 0.79-12.47). Although the relation was only slightly significant (P =.054), per-capita PMI spending was connected with a slight rise in artemisinin-based combination therapy coverage (3.56%, 95% CI 0.79-12.47).
“Despite PMI’s achievements, population coverage of key malaria interventions remained low throughout most of the African region,” Jakubowski and colleagues wrote. “As of 2015, most PMI countries were under target for key populations sleeping under insecticide-treated nets and timely access to diagnostic tests and malaria medicines. Furthermore, PMI has scaled down or even suspended indoor residual spraying in some countries after worrying reports of resistance to insecticides have emerged and [the] cost of other insecticides increased substantially.”
Disclosure: All funding information is available within the study.
