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
| Autor: | Nancy Fullman, Marie Ng, Emmanuela Gakidou, Matthew T. Schneider, Felix Masiye, Tom Achoki, Peter Hangoma, Laura Dwyer-Lindgren, K. Ellicott Colson, Peter Mulenga |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Counterfactual thinking
business.industry Transmission (medicine) 030231 tropical medicine Psychological intervention Infant mortality Child mortality Pentavalent vaccine 03 medical and health sciences 0302 clinical medicine Infectious Diseases Environmental protection Virology Environmental health parasitic diseases Medicine Parasitology 030212 general & internal medicine business Socioeconomic status Health impact assessment |
| Zdroj: | The American Journal of Tropical Medicine and Hygiene. 97:58-64 |
| ISSN: | 1476-1645 0002-9637 |
| DOI: | 10.4269/ajtmh.15-0315 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|