Impact of Malaria Control on Mortality and Anemia among Tanzanian Children Less than Five Years of Age, 1999–2010Report as inadecuate

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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.


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.


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.


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.

Author: Paul Smithson , Lia Florey, S. Rene Salgado, Christine L. Hershey, Honorati Masanja, Achuyt Bhattarai, Alex Mwita, Peter D. McElr



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