Assessment of Malawi's success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation

Tanya Doherty, Wanga Zembe, Nobubelo Ngandu, Mary Kinney, Samuel Manda, Donela Besada, Debra Jackson, Karen Daniels, Sarah Rohde, Wim van Damme, Kate Kerber, Emmanuelle Daviaud, Igor Rudan, Maria Muniz, Nicholas P Oliphant, Texas Zamasiya, Jon Rohde, David Sanders

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BACKGROUND: Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies.

METHODS: We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007-2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013.

RESULTS: The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991-1995 to 119 deaths (95% CI 105 to 132) in the period 2006-2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide-treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses.

CONCLUSIONS: Malawi provides a strong example for countries in sub-Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community-based delivery platform, can lead to significant reductions in child mortality.

TaalEngels
TijdschriftJournal of Global Health
Volume5
Exemplaarnummer2
Pagina's (van-tot)020412
ISSN2047-2978
DOI's
StatusGepubliceerd - 2015

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