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Marked Increase in Child Survival after Four Years of Intensive Malaria Control

In malaria-endemic countries in Africa, a large proportion of child deaths are directly or indirectly attributable to infection with Plasmodium falciparum. Four years after high coverage, multiple malaria control interventions were introduced on Bioko Island, Equatorial Guinea, changes in infection with malarial parasites, anemia, and fever history in children were estimated and assessed in relation to changes in all-cause under-5 mortality. There were reductions in prevalence of infection (odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.2–0.46), anemia (OR = 0.11, 95% CI = 0.07–0.18), and reported fevers (OR = 0.41, 95% CI = 0.22–0.76) in children. Under-5 mortality fell from 152 per 1,000 births (95% CI = 122–186) to 55 per 1,000 (95% CI = 38–77; hazard ratio = 0.34 [95% CI = 0.23–0.49]). Effective malaria control measures can dramatically increase child survival and play a key role in achieving millennium development goals.

Received January 29, 2009. Accepted for publication March 6, 2009.

Acknowledgments: The authors thank the late Brian Sharp for his role in the design of the study and the interpretation of the entomology results; Adel Chaouch for invaluable support in the execution of the intervention; and Giovanna Baltazar, Manuel Yataco, and David Jituboh for contributions in ensuring the quality of the survey data.

^* Address correspondence to Immo Kleinschmidt, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: Immo.Kleinschmidt{at}lshtm.ac.uk

Authors’ addresses: Immo Kleinschmidt, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK, Tel: 44-0-20-7927-2103, E-mail: Immo.Kleinschmidt{at}lshtm.ac.uk. Christopher Schwabe, Medical Care Development International, 8401 Colesville Rd., Suite 425, Silver Spring, MD 20910, Tel: 301-562-1920, Fax: 301-562-1921, E-mail: cschwabe{at}mcd.org. Luis Benavente, Medical Care Development International, 8401 Colesville Rd., Suite 425, Silver Spring, MD 20910, Tel: 301-562-1920, Fax: 301-562-1921, E-mail: lbenavente{at}mcd.org. Miguel Torrez, Medical Care Development International, 8401 Colesville Rd., Suite 425, Silver Spring, MD 20910, Tel: 301-562-1920, Fax: 301-562-1921, E-mail: mitorrez{at}gmail.com. Frances C. Ridl, Medical Research Council, 491 Ridge Rd., Overport, Durban 4091, South Africa, Tel: 27-31-203-4700, Fax: 27-31-203-4704, E-mail: frances.ridl{at}mrc.ac.za. Jose Luis Segura, Medical Care Development International, 8401 Colesville Rd., Suite 425, Silver Spring, MD 20910, Tel: 301-562-1920, Fax: 301-562-1921, E-mail: lsegura1212{at}gmail.com. Paul Ehmer, Medical Care Development International, 8401 Colesville Rd., Suite 425, Silver Spring, MD 20910, Tel: 301-562-1920, Fax: 301-562-1921, E-mail: pehmer{at}mcd.org. Gloria Nseng Nchama, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea, E-mail: glorianseng{at}yahoo.es.

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