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



The impressive decline in child mortality that occurred in Rwanda from 1996–2000 to 2006–2010 coincided with a period of rapid increase of malaria control interventions such as indoor residual spraying (IRS); insecticide-treated net (ITN) distribution and use, and improved malaria case management. The impact of these interventions was examined through ecological correlation analysis, and robust decomposition analysis of contextual factors on all-cause child mortality. Child mortality fell 61% during the evaluation period and prevalence of severe anemia in children 6–23 months declined 71% between 2005 and 2010. These changes in malaria morbidity and mortality occurred concurrently with a substantial increase in vector control activities. ITN use increased among children under five, from 4% to 70%. The IRS program began in 2007 and covered 1.3 million people in the highest burden districts by 2010. At the same time, diagnosis and treatment with an effective antimalarial expanded nationally, and included making services available to children under the age of 5 at the community level. The percentage of children under 5 who sought care for a fever increased from 26% in 2000 to 48% in 2010. Multivariable models of the change in child mortality between 2000 and 2010 using nationally representative data reveal the importance of increasing ITN ownership in explaining the observed mortality declines. Taken as a whole, the evidence supports the conclusion that malaria control interventions contributed to the observed decline in child mortality in Rwanda from 2000 to 2010, even in a context of improving socioeconomic, maternal, and child health conditions.

[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.


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  1. National Institute of Statistics of Rwanda (NISR), 2012. Population and Housing Census. Available at: http://www.statistics.gov.rw/publication/rphc4-atlas. Accessed December 2016.
  2. National Institute of Statistics of Rwanda (NISR), 2011. Statistical Yearbook. Available at: http://www.statistics.gov.rw/publication/statistical-yearbook-2011. Accessed December 2016.
  3. Lyon B, Barnston AG, , 2005. ENSO and the spatial extent of interannual precipitation extremes in tropical land areas. J Clim 18: 50955109.
  4. President’s Malaria Initiative, 2015. Rwanda Malaria Operational Plan (MOP). Available at: www.pmi.gov. Accessed December 2016.
  5. President’s Malaria Initiative, 2009. Rwanda Malaria Operational Plan (MOP). Available at: www.pmi.gov. Accessed December 2016.
  6. Kleinschmidt I, Sharp B, Benavente LE, Schwabe C, Torrez M, Kuklinski J, Morris N, Raman J, Carter J, , 2006. Reduction in infection with Plasmodium falciparum one year after the introduction of malaria control interventions on Bioko Island, Equatorial Guinea. Am J Trop Med Hyg 74: 972978.
  7. Bhattarai A, ., 2007. Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. PLoS Med 4: e309.[Crossref]
  8. Smithson P, Florey L, Salgado SR, Hershey CL, Masanja H, Bhattarai A, Mwita A, McElroy PD, Tanzania Malaria Impact Evaluation Research Group, 2015. Impact of Malaria Control on Mortality and Anemia among Tanzanian Children Less than Five Years of Age, 1999-2010. Available at: https://www.pmi.gov/docs/default-source/default-document-library/pmi-reports/tanzania_ie_report.pdf.
  9. Smithson P, Florey L, Salgado SR, Hershey CL, Masanja H, Bhattarai A, Mwita A, McElroy PD, Tanzania Malaria Impact Evaluation Research Group, 2015. Impact of malaria control on mortality and anemia among Tanzanian children less than five years of age, 1999–2010. PLoS One 10: e0141112.
  10. Rwanda Malaria Impact Evaluation Group, 2015. Evaluation of the Impact of Malaria Control Interventions on All-Cause Mortality in Children under Five Years of Age in Rwanda, 2000–2010. Available at: www.pmi.gov. Accessed December 2016.
  11. Van Eijk AM, Hill J, Alegana VA, Kirui V, Gething PW, ter Kuile FO, Snow RW, , 2011. Coverage of malaria protection in pregnant women in sub-Saharan Africa: a synthesis and analysis of national survey data. Lancet Infect Dis 11: 190207.[Crossref]
  12. Rowe AK, ., 2007. Viewpoint: evaluating the impact of malaria control efforts on mortality in sub-Saharan Africa. Trop Med Int Health 12: 15241539.[Crossref]
  13. Victora CG, Black RE, Boerma JT, Bryce J, , 2011. Measuring impact in the Millennium Development Goal era and beyond: a new approach to large-scale effectiveness evaluations. Lancet 377: 8595.[Crossref]
  14. 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]
  15. Office National de la Population (ONAPO) Rwanda and ORC Macro, 2001. Enquête Démographique et de Santé, Rwanda 2000. Kigali, Rwanda: Ministère de la Santé, Office National de la Population and ORC Macro.
  16. Institut National de la Statistique du Rwanda (INSR) and ORC Macro, 2006. Rwanda Demographic and Health Survey 2005. Calverton, MD: INSR and ORC Macro.
  17. Ministry of Health (MOH) Rwanda, National Institute of Statistics of Rwanda (NISR), and ICF Macro, 2009. Rwanda Interim Demographic and Health Survey 2007–08. Calverton, MD: MOH/Rwanda, NISR/Rwanda, and ICF Macro.
  18. National Institute of Statistics of Rwanda, Ministry of Finance and Economic Planning/Rwanda, Ministry of Health/Rwanda, and ICF International, 2015. Rwanda Demographic and Health Survey 2014–15. Kigali, Rwanda: National Institute of Statistics of Rwanda, Ministry of Finance and Economic Planning/Rwanda, Ministry of Health/Rwanda, and ICF International.
  19. Dinku T, , 2014. Reconstructing Rwanda’s Historical Climate Data. International Research Institute for Climate and Society. New York, NY: Earth Institute, Columbia University.
  20. Althauser RP, Wigler M, , 1972. Standardization and component analysis. Sociol Methods Res 1: 97135.[Crossref]
  21. StataCorp, 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.
  22. Powers DA, Yoshioka H, Yun MS, , 2011. mvdcmp: multivariate decomposition for nonlinear response models. Stata J 11: 556576.
  23. Grover-Kopec E, ., 2006. Web-based climate information resources for alaria control in Africa. Malar J 5: 38.[Crossref]
  24. Walker N, Schwartlander B, Bryce J, , 2002. Meeting international goals in child survival and HIV/AIDS. Lancet 360: 284289.[Crossref]
  25. Stanecki K, Daher J, Stover J, Akwara P, Mahy M, , 2010. Under-5 mortality due to HIV: regional levels and 1990–2009 trends. Sex Transm Infect 86: ii56ii61.
  26. Karema C, ., 2012. Trends in malaria cases, hospital admissions and deaths following scale-up of anti-malarial interventions, 2000–2010, Rwanda. Malar J 11: 236.[Crossref]
  27. United Nations Inter-Agency Group for Child Mortality Estimation, 2015. Levels and Trends in Child Mortality. New York, NY: UNICEF.
  28. Lim SS, Fullman N, Stokes A, Ravishankar N, Masiye F, Murray CJL, Gakidou E, , 2011. Net benefits: a multicountry analysis of observationa data examining associations between insecticide-treated nets and health outcomes. PLoS Med 8: e1001091.[Crossref]

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  • Received : 05 Apr 2017
  • Accepted : 01 Jun 2017

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