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Publication date: 
February 15, 2016


Under-5 mortality in Zambia has declined since 1990, with reductions accelerating after 2000. Zambia’s scale-up of malaria control is viewed as the driver of these gains, but past studies have not fully accounted for other potential factors. This study sought to systematically evaluate the impact of malaria vector control on under-5 mortality.


Using a mixed-effects regression model, we quantified the relationship between malaria vector control, other priority health interventions, and socioeconomic indicators and district-level under-5 mortality trends from 1990 to 2010. We then conducted counterfactual analyses to estimate under-5 mortality in the absence of scaling up malaria vector control.


Throughout Zambia, increased malaria vector control coverage coincided with scaling up three other interventions: the pentavalent vaccine, exclusive breastfeeding, and prevention of mother-to-child transmission of HIV (PMTCT) services. This simultaneous scale-up made statistically isolating intervention-specific impact infeasible. Instead, in combination, these interventions jointly accelerated declines in under-5 mortality by 11% between 2000 and 2010.


Zambia’s scale-up of multiple interventions is notable, yet our findings highlight challenges in quantifying program-specific impact without better health data and information systems. As countries aim to further improve health outcomes, there is even greater need – and opportunity – to strengthen routine data systems and to develop more rigorous evaluation strategies.


Bill & Melinda Gates Foundation – Malaria Country Progress Assessment (Investment #OPPGH4636)


Ng M, Colson KE, Fullman N, Dwyer-Lindgren L, Achoki T, Schneider MT, Mulenga P, Hangoma P, Masiye F, Gakidou E. Assessing the contribution of malaria vector control and other maternal and child health interventions in reducing all-cause under-5 mortality in Zambia. American Journal of Tropical Medicine and Hygiene. 2016 Feb 15. doi: 10.4269/ajtmh.15-0315.