Child mortality patterns in rural tanzania: An observational study on the impact of malaria control interventions
International Journal of Epidemiology
Royal Tropical Institute (KIT), KIT Biomedical Research, Amsterdam, Netherlands; Ifakara Health Institute, Dar es Salaam, Tanzania; Novartis Foundation for Sustainable Development, Basel, Switzerland; Tanzania Commission for Science and Technology, Dar es Salaam, Tanzania; Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Switzerland; Faculty of Science, University of Basel, Basel, Switzerland
Background: Between 1997 and 2009, a number of key malaria control interventions were implemented in the Kilombero and Ulanga Districts in south central Tanzania to increase insecticide-treated nets (ITN) coverage and improve access to effective malaria treatment. In this study we estimated the contribution of these interventions to observed decreases in child mortality. Methods: The local Health and Demographic Surveillance Site (HDSS) provided monthly estimates of child mortality rates (age 1 to 5 years) expressed as cases per 1000 person-years (c/1000py) between 1997 and 2009. We conducted a time series analysis of child mortality rates and explored the contribution of rainfall and household food security. We used Poisson regression with linear and segmented effects to explore the impact of malaria control interventions on mortality. Results: Child mortality rates decreased by 42.5% from 14.6 c/1000py in 1997 to 8.4 c/1000py in 2009. Analyses revealed the complexity of child mortality patterns and a strong association with rainfall and food security. All malaria control interventions were associated with decreases in child mortality, accounting for the effect of rainfall and food security. Conclusions: Reaching the fourth Millenium Development Goal will require the contribution of many health interventions, as well as more general improvements in socio-environmental and nutritional conditions. Distinguishing between the effects of these multiple factors is difficult and represents a major challenge in assessing the effect of routine interventions. However, this study suggests that credible estimates can be obtained when high-quality data on the most important factors are available over a sufficiently long time period. © The Author 2013.
chloroquine; pyrimethamine plus sulfadoxine; rain; antimalarial agent; child health; data set; disease control; food security; insecticide; malaria; mortality; observational method; rural area; article; bed net; child; childhood mortality; controlled study; food security; health impact assessment; household; human; major clinical study; malaria; malaria control; observational study; preschool child; priority journal; rural area; Tanzania; time series analysis; catering service; female; health care delivery; intervention study; malaria; male; mosquito; nutritional status; procedures; rural population; season; socioeconomics; statistics and numerical data; utilization; Tanzania; Antimalarials; Child; Child Mortality; Female; Food Supply; Health Services Accessibility; Humans; Insecticide-Treated Bednets; Intervention Studies; Malaria; Male; Mosquito Control; Nutritional Status; Rural Population; Seasons; Socioeconomic Factors; Tanzania