Smithson P., Florey L., Salgado S.R., Hershey C.L., Masanja H., Bhattarai A., Mwita A., McElroy P.D.
Ifakara Health Institute, Dar es Salaam, Tanzania; ICF International, Rockville, MD, United States; United States Agency for International Development, U.S. President's Malaria Initiative, Washington, DC, United States; Centers for Disease Control and Prevention, U.S. President's Malaria Initiative, Atlanta, GA, United States; National Malaria Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
Smithson, P., Ifakara Health Institute, Dar es Salaam, Tanzania; Florey, L., ICF International, Rockville, MD, United States; Salgado, S.R., United States Agency for International Development, U.S. President's Malaria Initiative, Washington, DC, United States; Hershey, C.L., United States Agency for International Development, U.S. President's Malaria Initiative, Washington, DC, United States; Masanja, H., Ifakara Health Institute, Dar es Salaam, Tanzania; Bhattarai, A., Centers for Disease Control and Prevention, U.S. President's Malaria Initiative, Atlanta, GA, United States; Mwita, A., National Malaria Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania; McElroy, P.D., Centers for Disease Control and Prevention, U.S. President's Malaria Initiative, Atlanta, GA, United States
Background: Mainland Tanzania scaled up multiple malaria control interventions between 1999 and 2010. We evaluated whether, and to what extent, reductions in all-cause under-five child mortality (U5CM) tracked with malaria control intensification during this period. Methods: Four nationally representative household surveys permitted trend analysis for malaria intervention coverage, severe anemia (hemoglobin <8 g/dL) prevalence (SAP) among children 6-59 months, and U5CM rates stratified by background characteristics, age, and malaria endemicity. Prevalence of contextual factors (e.g., vaccination, nutrition) likely to influence U5CM were also assessed. Population attributable risk percentage (PAR%) estimates for malaria interventions and contextual factors that changed over time were used to estimate magnitude of impact on U5CM. Results: Household ownership of insecticide-treated nets (ITNs) rose from near zero in 1999 to 64% (95% CI, 61.7-65.2) in 2010. Intermittent preventive treatment of malaria in pregnancy reached 26% (95% CI, 23.6-28.0) by 2010. Sulfadoxine-pyrimethamine replaced chloroquine in 2002 and artemisinin-based combination therapy was introduced in 2007. SAP among children 6-59 months declined 50% between 2005 (11.1%; 95% CI, 10.0-12.3%) and 2010 (5.5%; 95% CI, 4.7-6.4%) and U5CM declined by 45% between baseline (1995-9) and endpoint (2005-9), from 148 to 81 deaths/1000 live births, respectively. Mortality declined 55% among children 1-23 months of age in higher malaria endemicity areas. A large reduction in U5CM was attributable to ITNs (PAR%= 11) with other malaria interventions adding further gains. Multiple contextual factors also contributed to survival gains. Conclusion: Marked declines in U5CM occurred in Tanzania between 1999 and 2010 with high impact from ITNs and ACTs. High-risk children (1-24 months of age in high malaria endemicity) experienced the greatest declines in mortality and SAP. Malaria control should remain a policy priority to sustain and further accelerate progress in child survival.