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J Glob Health. 2015 Dec;5(2):020412. doi: 10.7189/jogh.05.020412.

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

Author information

1
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa ; School of Public Health, University of the Western Cape, Cape Town, South Africa ; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
2
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
3
Saving Newborn Lives/Save the Children, Cape Town, South Africa.
4
Biostatistics Research Unit, South African Medical Research Council, Pretoria, South Africa ; School of Mathematics, Statistics and Computer Science, University of Kwazulu-Natal, Durban, South Africa.
5
School of Public Health, University of the Western Cape, Cape Town, South Africa ; UNICEF, United Nations Plaza, New York, NY, USA.
6
School of Public Health, University of the Western Cape, Cape Town, South Africa ; Institute of Tropical Medicine, Antwerp, Belgium.
7
Centre for Global Health Research and Global Health Academy, University of Edinburgh Medical School, Edinburgh, Scotland, UK.
8
UNICEF, United Nations Plaza, New York, NY, USA.
9
UNICEF, Lilongwe, Malawi.
10
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa ; School of Public Health, University of the Western Cape, Cape Town, South Africa.
11
School of Public Health, University of the Western Cape, Cape Town, South Africa ; School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa.

Abstract

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.

PMID:
26649176
PMCID:
PMC4652924
DOI:
10.7189/jogh.05.020412
[Indexed for MEDLINE]
Free PMC Article

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