Secondary analysis of national and subnational survey data to evaluate the impact of the scale-up of malaria control interventions in Malawi, 2000–10

Abstract Background Malaria control interventions, including insecticide-treated nets (ITNs), were scaled up nationwide in Malawi during 2000–10. We assessed trends and associations of ITN coverage, malaria morbidity, and all-cause mortality in children under 5 years of age under programmatic conditions in Malawi during 2000–10. Methods Trends in household ITN ownership, malaria parasitaemia, and anaemia (haemoglobin Findings Household ITN ownership increased from 27·4% (95% CI 25·9–29·0) in 2004, to 56·8% (55·6–58·1) in 2010. Malaria parasitaemia decreased from 60·5% (95% CI 53·0–68·0) in 2001, to 20·4% (15·7–25·1) in 2009, in children aged 6–35 months. Anaemia decreased from 20·4% (95% CI 17·3–24·0) in 2004, to 13·1% (11·0–15·4) in 2010, in children aged 6–23 months. ACCM decreased by 41% from 188·3 deaths per 1000 livebirths (95% CI 179·2–197·3) during 1996–2000, to 112·1 per 1000 livebirths (106·1–118·0) during 2006–10. Household ITN ownership was protective against malaria parasitaemia (odds ratio 0·81, 95% CI 0·72–0·92) and anaemia (0·77, 0·70–0·86) after controlling for other covariates. ITN distributions per 1000 population were not significantly associated with malaria cases at IDSR facilities. District-level household ITN ownership was significantly associated with child survival (incidence rate ratio 0·55, 95% CI 0·31–0·99) after controlling for other covariates. Interpretation Household ITN ownership was protective against malaria parasitaemia, anaemia, and child mortality. Scale-up of malaria control interventions during 2000–10 was likely associated with improved child survival in Malawi. Funding Financial support for this study was received from the United States President's Malaria Initiative.