The President's Malaria Initiative contributed to reducing malaria burden in sub-Saharan Africa between 2004 and 2014: Evidence from generalized estimating equation analysis
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Date
2019-05-03
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS ONE
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 PMIrecipient
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.
Description
Research Article
Keywords
Malaria, Sub-Saharan Africa, Estimating equation analysis, Evidence