Volume 97 Number 3_Suppl
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Concerted efforts from national and international partners have scaled up malaria control interventions, including insecticide-treated nets, indoor residual spraying, diagnostics, prompt and effective treatment of malaria cases, and intermittent preventive treatment during pregnancy in sub-Saharan Africa (SSA). This scale-up warrants an assessment of its health impact to guide future efforts and investments; however, measuring malaria-specific mortality and the overall impact of malaria control interventions remains challenging. In 2007, Roll Back Malaria's Monitoring and Evaluation Reference Group proposed a theoretical framework for evaluating the impact of full-coverage malaria control interventions on morbidity and mortality in high-burden SSA countries. Recently, several evaluations have contributed new ideas and lessons to strengthen this plausibility design. This paper harnesses that new evaluation experience to expand the framework, with additional features, such as stratification, to examine subgroups most likely to experience improvement if control programs are working; the use of a national platform framework; and analysis of complete birth histories from national household surveys. The refined framework has shown that, despite persisting data challenges, combining multiple sources of data, considering potential contributions from both fundamental and proximate contextual factors, and conducting subnational analyses allows identification of the plausible contributions of malaria control interventions on malaria morbidity and mortality.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. WHO, 2014. World Malaria Report. Geneva, Switzerland: World Health Organization.
  2. Division of Malaria Control, Ministry of Health, Republic of Kenya, National Malaria Strategy 2001–2010, April 2001, Nairobi, Kenya.
  3. Programme National de Lutte contre le Paludisme, Ministère de la Santé Publique, 2012. Le plan stratégique de lutte contre le paludisme Madagascar 2013–2017. Antananarivo, Madagascar.
  4. Craig P, Dieppe P, Macintyre S, Michi S, Nazareth I, Petticrew M, , 2008. Developing and evaluating complex interventions: new guidance. Medical Research Council. Available at: http://www.mrc.ac.uk/documents/pdf/complex-interventions-guidance. Accessed April 23, 2015.
  5. Khandker RS, Koolwal GB, Samad HA, , 2010. Handbook on Impact Evaluation: Quantitative Methods and Practices (World Bank Training Series). Washington, DC: The International Bank for Reconstruction and Development, The World Bank. eISBN: 978-0-8213-8029-1.
  6. Rowe AK, Steketee RW, Arnold F, Wardlaw T, Basu S, Bakyaita N, Lama M, Winston CA, Lynch M, Cibulskis RE, Shibuya K, Ratcliffe AA, Nahlen BL, , Roll Back Malaria Monitoring and Evaluation Reference Group, 2007. Viewpoint: evaluating the impact of malaria control efforts on mortality in sub-Saharan Africa. Trop Med Int Health 12: 15241539.[Crossref] [Google Scholar]
  7. Habicht JP, Victoria CG, Vaughan JP, , 1999. Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact. Int J Epidemiol 28: 1018.[Crossref] [Google Scholar]
  8. Tanzania Malaria Impact Evaluation Research Group, 2012. Evaluation of the Impact of Malaria Interventions on Mortality in Children in Mainland Tanzania. Available at http://www.pmi.gov/docs/default-source/default-document-library/tools-curricula/tanzania_ie_report.pdf?sfvrsn=4. Accessed April 23, 2015.
  9. Kleinschmidt I, Schwabe C, Benavente L, Torrez M, Ridl FC, Segura JL, Ehmer P, Nchama GN, , 2009. Marked increase in child survival after four years of intensive malaria control. Am J Trop Med Hyg 2009 80: 882888. [Google Scholar]
  10. Gertler PJ, Martinez S, Premand P, Rawlings LB, Vermeersch CMJ, , 2011. Impact Evaluation in Practice. Washington, DC: The International Bank for Reconstruction and Development, The World Bank. eISBN: 978-0-8213-8593-7.
  11. Victora CG, Schellenberg JA, Huicho L, Amaral J, El Arifeen S, Pariyo G, Manzi F, Scherpbier RW, Bryce J, Habicht JP, , 2005. Context matters: interpreting impact findings in child survival evaluations. Health Policy Plan 20 (Suppl 1): i18i31.[Crossref] [Google Scholar]
  12. Lengeler C, , 2004. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database Syst Rev CD000363. [Google Scholar]
  13. Florey LS, Bennett A, Hershey CL, Bhattarai A, Nielsen C, Ali D, Luhanga M, Cameron Taylor C, Eisele T, Ye Y, , 2017. Impact of scale-up of district-level insecticide-treated net (ITN) distribution on all-cause child mortality in Malawi, 2004–2010: a summary of regression analysis results. Am J Trop Med Hyg 97 (Suppl 3): 6575. [Google Scholar]
  14. Lindblade KA, Eisele TP, Gimnig JE, Alaii JA, Odhiambo F, ter Kuile FO, Hawley WA, Wannemuehler KA, Phillips-Howard PA, Rosen DH, Nahlen BL, Terlouw DJ, Adazu K, Vulule JM, Slutsker L, , 2004. Sustainability of reductions in malaria transmission and infant mortality in western Kenya with use of insecticide-treated bednets: 4 to 6 years of follow-up. JAMA 291: 25712580.[Crossref] [Google Scholar]
  15. Hershey CL, Bhattarai A, Florey LS, Nielsen CF, Ye Y, Eckert E, Franca-Koh AC, , Shargie E5, Komatsu R, Smithson P, Taylor C, Herrera S, Shah J, Mouzin E, Yoon S, Salgado, 2017. Implementing impact evaluations of malaria control interventions: process, lessons learned and recommendations from RBM impact evaluations. Am J Trop Med Hyg 97 (Suppl 3): 2031. [Google Scholar]
  16. World Health Organization, 2010. A manual for Reviewing the Performance of Malaria Control and Elimination Programmes, Geneva. Available at: http://www.who.int/malaria/publications/atoz/whomprmalariaprogramperformancemanual.pdf?ua=1. Accessed July 21, 2015. [Google Scholar]
  17. Roll Back Malaria, 2013. Household Survey Indicators for Malaria Control. Rockville, MD. [Google Scholar]
  18. Ye Y, Wamukoya M, Ezeh A, Emina J, Osman S, , 2012. Health and demographic surveillance systems: a step towards full civil registration and vital statistics system in sub-Sahara Africa? BMC Public Health 12: 741.[Crossref] [Google Scholar]
  19. Korenromp EL, , Armstrong-Schellenberg JR, Williams BG, Nahlen BL, Snow RW, 2004. Impact of malaria control on childhood anaemia in Africa—a quantitative review. Trop Med Int Health 9: 10501065.[Crossref] [Google Scholar]
  20. Onori E, Grab B, , 1980. Indicators for the forecasting of malaria epidemics. Bull World Health Organ 58: 9198. [Google Scholar]
  21. Shililu J, Ghebremeskel T, Mengistu S, Fekadu H, Zerom M, Mbogo C, Githure J, Novak R, Brantly E, Beier JC, , 2003. High seasonal variation in entomologic inoculation rates in Eritrea, a semi-arid region of unstable malaria in Africa. Am J Trop Med Hyg 69: 607613. [Google Scholar]
  22. Garenne M, Fontaine O, , 2006. Potential and limits of verbal autopsies. Bull World Health Organ 84: 164.[Crossref] [Google Scholar]
  23. Byass P, , 2014. Usefulness of the Population Health Metrics Research Consortium gold standard verbal autopsy data for general verbal autopsy methods. BMC Med 12: 23.[Crossref] [Google Scholar]
  24. Soleman N, Chandramohan D, Shibuya K, , 2006. Verbal autopsy: current practices and challenges. Bull World Health Organ 84: 239245.[Crossref] [Google Scholar]
  25. Baiden F, Bawah A, Biai S, Binka F, Boerma T, Byass P, Chandramohan D, Chatterji S, Engmann C, Greet D, Jakob R, Kahn K, Kunii O, Lopez AD, Murray CJ, Nahlen B, Rao C, Sankoh O, Setel PW, Shibuya K, Soleman N, Wright L, Yang G, , 2007. Setting international standards for verbal autopsy. Bull World Health Organ 85: 570571.[Crossref] [Google Scholar]
  26. Joshi R, Kengne AP, Neal B, , 2005. Methodological trends in studies based on verbal autopsies in a rural area of South Africa. Trop Med Int Health 5: 824831. [Google Scholar]
  27. Murray CJL, James SL, Birnbaum JK, Freeman MK, Lozano R, Lopez AD, ; and the Population Health Metrics Research Consortium (PHMRC), 2011. Simplified symptom pattern method for verbal autopsy analysis: multisite validation study using clinical diagnostic gold standards. Popul Health Metr 9. [Google Scholar]
  28. Streatfield PK, Khan WA, Bhuiya A, Hanifi SM, Alam N, Diboulo E, Sié A, M, Compaoré Y, Soura AB, Bonfoh B, Jaeger F, Ngoran EK, Utzinger J, Melaku YA, Mulugeta A, Weldearegawi B, Gomez P, Jasseh M, Hodgson A, Oduro A, Welaga P, Williams J, Awini E, Binka FN, Gyapong M, Kant S, Misra P, Srivastava R, Chaudhary B, Juvekar S, Wahab A, Wilopo S, Bauni E, Mochamah G, Ndila C, Williams TN, Desai M, Hamel MJ, Lindblade KA, Odhiambo FO, Slutsker L, Ezeh A, Kyobutungi C, Wamukoya M, Delaunay V, Diallo A, Douillot L, Sokhna C, Gómez-Olivé FX, Kabudula CW, Mee P, Herbst K, Mossong J, Chuc NT, Arthur SS, Sankoh OA, Tanner M, Byass P, , 2014. Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Glob Health Action 7: 25369.[Crossref] [Google Scholar]
  29. Phillips DE, AbouZahr C, Lopez AD, Mikkelsen L, de Savigny D, Lozano R, Wilmoth J, Setel PW, , 2015. Are well functioning civil registration and vital statistics systems associated with better health outcomes The Lancet 386: 13861394. [Crossref] [Google Scholar]
  30. Mikkelsen L, Phillips DE, AbouZahr C, Setel PW, de Savigny D, Lozano R, Lopez AD, , 2015. A global assessment of civil registration and vital statistics systems: monitoring data quality and progress. The Lancet 386: 13951406. [Crossref] [Google Scholar]
  31. Snow RW, Korenromp EL, Gouws E, , 2004. Paediatric mortality in Africa: Plasmodium falciparum malaria as a cause or risk? Am J Trop Med Hyg 71(Suppl 2): 1624.[Crossref] [Google Scholar]
  32. World Health Organization, 2012. Disease Surveillance for Malaria Elimination: Operational Manual. Geneva, Switzerland: WHO. ISBN 978 92 4 150333 4.
  33. The Global Fund to Fight AIDS Tuberculosis and Malaria, 2011. The Global Fund Results Report 2011: Making a Difference. Geneva, Switzerland: WHO.
  34. Bhattarai A, Ali AS, Kachur SP, Mårtensson A, Abbas AK, Khatib R, Al-Mafazy AW, Ramsan M, Rotllant G, Gerstenmaier JF, Molteni F, Abdulla S, Montgomery SM, Kaneko A, Björkman A, , 2007. Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. PLos Med 4: e309.[Crossref] [Google Scholar]
  35. Aregawi MW, Ali AS, Al-mafazy AW, Molteni F, Katikiti S, Warsame M, Njau RJ, Komatsu R, Korenromp E, Hosseini M, Low-Beer D, Bjorkman A, D'Alessandro U, Coosemans M, Otten M, , 2011. Reductions in malaria and anemia case and death burden to hospitals following scale-up of malaria control in Zanzibar, 1999–2008. Malaria J 10: 46.[Crossref] [Google Scholar]
  36. Kleinschmidt I, Schwabe C, Benavente L, Torrez M, Ridl FC, Segura JL, Ehmer P, Nchama GN, , 2009. Marked increase in child survival after four years of intensive malaria control. Am J Trop Med Hyg 80: 882888. [Google Scholar]
  37. Greenwell F, Neuman M, , 2006. Children's Anemia Levels in West Africa: A Good Proxy for Malaria Morbidity? Population Association of America Annual Meeting. Los Angeles, California.
  38. Snow RW, Marsh K, , 2002. The consequences of reducing transmission of Plasmodium falciparum in Africa. Adv Parasitol 52: 235264.[Crossref] [Google Scholar]
  39. Carneiro I, Roca-Feltrer A, Griffin JT, Smith L, Tanner M, Armstrong Schellenberg J, Greenwood BM, Schellenberg D, , 2010. Age-patterns of malaria vary with severity, transmission intensity and seasonality in sub-Saharan Africa: a systematic review and pooled analysis. PLoS One 5: e8988.[Crossref] [Google Scholar]
  40. Roca-Feltrer A, Carneiro I, Smith L, Schellenberg J, Greenwood B, Schellenberg D, , 2010. The age patterns of severe malaria syndromes in sub-Saharan Africa across a range of transmission intensities and seasonality settings. Malaria J 9: 282.[Crossref] [Google Scholar]
  41. Bennett A, Yukich J, Miller JM, Vounatsou P, Hamainza B, Ingwe MM, Moonga HB, Kamuliwo M, Keating J, Smith TA, Steketee RW, Eisele TP, , 2014. A methodological framework for the improved use of routine health system data to evaluate national malaria control programs: evidence from Zambia. Popul Health Metr 12: 30.[Crossref] [Google Scholar]
  42. Bryce J, Gilroy K, Jones G, Hazel E, Black RE, Victora CG, , 2010. The accelerated child survival and development programme in West Africa: a retrospective evaluation. Lancet 375: 57282.[Crossref] [Google Scholar]
  43. Graves PM, Osgood DE, Thomson MC, Sereke K, Araia A, Zerom M, Ceccato P, Bell M, Del Corral J, Ghebreselassie S, Brantly EP, Ghebremeskel T, , 2008. Effectiveness of malaria control during changing climate conditions in Eritrea, 1998–2003. Trop Med Int Health 13: 218228.[Crossref] [Google Scholar]
  44. de Savigny D and Adam T, eds., 2009. Systems Thinking for Health Systems Strengthening: Alliance for Health Policy and Systems Research and WHO. Geneva, Switzerland.

Data & Media loading...

  • Received : 15 May 2015
  • Accepted : 23 Nov 2015
  • Published online : 27 Sep 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error