Strategy, Performance and Evaluation Cluster, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
PLoS One. 2011;6(6):e21309. doi: 10.1371/journal.pone.0021309. Epub 2011 Jun 30.
Around 8.8 million children under-five die each year, mostly due to infectious diseases, including malaria that accounts for 16% of deaths in Africa, but the impact of international financing of malaria control on under-five mortality in sub-Saharan Africa has not been examined.
We combined multiple data sources and used panel data regression analysis to study the relationship among investment, service delivery/intervention coverage, and impact on child health by observing changes in 34 sub-Saharan African countries over 2002-2008. We used Lives Saved Tool to estimate the number of lives saved from coverage increase of insecticide-treated nets (ITNs)/indoor residual spraying (IRS). As an indicator of outcome, we also used under-five mortality rate. Global Fund investments comprised more than 70% of the Official Development Assistance (ODA) for malaria control in 34 countries. Each $1 million ODA for malaria enabled distribution of 50,478 ITNs [95%CI: 37,774-63,182] in the disbursement year. 1,000 additional ITNs distributed saved 0.625 lives [95%CI: 0.369-0.881]. Cumulatively Global Fund investments that increased ITN/IRS coverage in 2002-2008 prevented an estimated 240,000 deaths. Countries with higher malaria burden received less ODA disbursement per person-at-risk compared to lower-burden countries ($3.90 vs. $7.05). Increased ITN/IRS coverage in high-burden countries led to 3,575 lives saved per 1 million children, as compared with 914 lives in lower-burden countries. Impact of ITN/IRS coverage on under-five mortality was significant among major child health interventions such as immunisation showing that 10% increase in households with ITN/IRS would reduce 1.5 [95%CI: 0.3-2.8] child deaths per 1000 live births.
Along with other key child survival interventions, increased ITNs/IRS coverage has significantly contributed to child mortality reduction since 2002. ITN/IRS scale-up can be more efficiently prioritized to countries where malaria is a major cause of child deaths to save greater number of lives with available resources.
每年约有 880 万五岁以下儿童死亡，主要死于传染病，包括在非洲造成 16%儿童死亡的疟疾，但尚未研究国际疟疾控制融资对撒哈拉以南非洲五岁以下儿童死亡率的影响。
我们结合了多个数据源，并使用面板数据分析，通过观察 2002-2008 年 34 个撒哈拉以南非洲国家的变化，研究投资、服务提供/干预覆盖率以及对儿童健康的影响之间的关系。我们使用 Lives Saved Tool 来估计因增加杀虫剂处理过的蚊帐（ITN）/室内残留喷洒（IRS）覆盖率而拯救的生命数量。作为结果指标，我们还使用了五岁以下儿童死亡率。在 34 个国家，全球基金投资占疟疾官方发展援助（ODA）的 70%以上。疟疾 ODA 每增加 100 万美元，就能在拨款年度发放 50478 顶 ITN[95%CI：37774-63182]。额外发放 1000 顶 ITN 可拯救 0.625 条生命[95%CI：0.369-0.881]。2002-2008 年，全球基金投资增加了 ITN/IRS 覆盖率，估计预防了 24 万人死亡。疟疾负担较高的国家每人获得的疟疾 ODA 拨款低于负担较低的国家（3.90 美元对 7.05 美元）。高负担国家增加 ITN/IRS 覆盖率导致每 100 万儿童可挽救 3575 条生命，而低负担国家则可挽救 914 条生命。ITN/IRS 覆盖率对五岁以下儿童死亡率的影响在主要儿童健康干预措施中很显著，如免疫接种，表明每增加 10%拥有 ITN/IRS 的家庭，每 1000 例活产就会减少 1.5 例[95%CI：0.3-2.8]儿童死亡。
自 2002 年以来，随着其他关键儿童生存干预措施的实施，增加 ITN/IRS 覆盖率显著有助于降低儿童死亡率。在疟疾是儿童死亡主要原因的国家，可更有效地优先扩大 ITN/IRS 规模，用现有资源挽救更多生命。
