Abstract
The President’s Malaria Initiative (PMI) launched in 2005 as a key player in malaria prevention and treatment in sub-Saharan Africa (SSA). Several country-specific evaluations have demonstrated great progress in reducing under-five mortality associated with scaling up malaria interventions in PMI priority countries. Documentation of PMI’s specific contributions was limited, until the publication of Jakubowski, et al., which used difference-in-difference analysis to show a higher reduction of under-five mortality in PMI-supported countries than in others. To generate more evidence, this study used rigorous statistical analyses to assess the reduction in mortality attributable to PMI support. The study used generalized estimating equations and a series of matching procedures to evaluate the impact of PMI on under-five mortality and on population coverage of insecticide-treated nets (ITNs), indoor residual spraying (IRS), and artemisinin-based combination therapy (ACT) in SSA. The analyses used country-level secondary data and controlled for several country-level characteristics assumed to influence outcome measures of interest, PMI program participation, or both. The Mahalanobis distance metric, with 1:1 nearest neighbor matching adjusting for bias in population size in the particular country, showed a reduction in under-five mortality by approximately 12 per 1,000 live births (95% Confidence Interval [CI]: 20.6–3.1; p = 0.012). There were statistically significant increases in the population coverage of ITNs, IRS, and ACTs in PMI countries over the implementation period. ITN use in the population was 0.23% higher (95% CI average treatment effect on the treated: 0.17–0.30; p<0.001) in PMI-recipient countries than in non-PMI countries. The findings show that PMI contributed significantly to increasing the coverage of malaria control interventions and reducing under-five mortality in SSA.
Highlights
Many government and international organizations, including the United States, have established reducing mortality among children under the age of five to the barest minimum as their primary goal
This study evaluated the impact of President’s Malaria Initiative (PMI) on reducing U5M rates (U5MRs) and increasing population coverage of insecticide-treated nets (ITNs), indoor residual spraying (IRS), and artemisinin-based combination therapy (ACT) using population-averaged regression models for panel data analysis and matching procedures, which serve as one of several methods of estimating the causal effect of interventions using observational data
PMI was found to have statistically significant impact on the reductions in all-cause mortality rates among children under five and in the increase in population coverage of ITNs, IRS, and ACTs. These findings were consistent with the results obtained by Jakubowski, et al, [1] who used a DID analytic technique to determine significant statistical associations between PMI support and U5MR, ITNs, ACTs, and IRS
Summary
Many government and international organizations, including the United States, have established reducing mortality among children under the age of five to the barest minimum as their primary goal. The U.S Government, through the President’s Malaria Initiative (PMI), has invested significant funds in the health sector, in subSaharan Africa (SSA), contributing to an expansion of key malaria prevention and treatment interventions with the potential to significantly reduce malaria burden [1,2,3]. Several country-specific impact evaluations have been conducted in PMI-supported countries, using the plausibility argument, to assess the change in all-cause child mortality associated with expansion of malaria interventions over the past decade. These evaluations documented significant progress in most of the countries [4,5,6,7]. The design of the evaluation could not measure the specific contribution of PMI to changes observed
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