Volume 80, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


In malaria-endemic countries in Africa, a large proportion of child deaths are directly or indirectly attributable to infection with . 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.


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  1. United Nations Millennium Development Goals. Available at: http://www.un.org/millenniumgoals/index.html. Accessed August 4, 2008.
  2. World Health Organization, 2000. The African Summit on Roll Back Malaria, Abuja, Nigeria, 25th April 2000. Geneva: World Health Organization.
  3. The Global Malaria Action Plan, 2008. The Roll Back Malaria Partnership. Available at: http://www.rbm.who.int/gmap/gmap.pdf. Accessed March 2, 2009.
  4. Rowe AK, Steketee RW, 2007. Predictions of the impact of malaria control efforts on all-cause child mortality in sub-Saharan Africa. Am J Trop Med Hyg 77 (Suppl): 48–55.
  5. Rowe AK, Rowe SY, Snow RW, Korenromp EL, Schellenberg JR, Stein C, Nahlen BL, Bryce J, Black RE, Steketee RW, 2006. The burden of malaria mortality among African children in the year 2000. Int J Epidemiol 35 : 691–704.
  6. Lengeler C, 2004. Insecticide-treated nets and curtains for preventing malaria. Cochrane Database Syst Rev 2 : CD000363.
  7. 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.
  8. World Health Organization, 2006. Global malaria programme. Indoor residual spraying. WHO position statement. Available at: http://www.who.int/malaria/docs/IRS/IRS-position.pdf. Accessed August 4, 2008.
  9. The President’s Malaria Initiative, 2008. Second annual report. Available at: http://www.fightingmalaria.gov/resources/pmi_annual_report08.pdf. Accessed August 4, 2008.
  10. Global Fund Malaria Programs Coverage, 2006. The global fund to fight AIDS, tuberculosis, and malaria. Available at: http://www.theglobalfund.org/en/files/malaria_information_sheet_en.pdf. Accessed August 4, 2008.
  11. Sharp BL, Kleinschmidt I, Streat E, Maharaj R, Barnes KI, Durrheim DN, Ridl FC, Morris N, Seocharan I, Kunene S, La Grange JJP, Mthembu DJ, Maartens F, Martin CL, Barreto A, 2007. Seven years of regional malaria control collaboration: Mozambique, South Africa and Swaziland. Am J Trop Med Hyg 76 : 42–47.
  12. Shanks GD, Hay SI, Bradley DJ, 2008. Malaria’s indirect contribution to all-cause mortality in the Andaman Islands during the colonial era. Lancet Infect Dis 8 : 564–570.
  13. 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 : 1524–1539.
  14. Kleinschmidt I, Sharp B, Benavente L, Schwabe C, Torrez M, Kuklinski J, Morris N, Raman J, Carter J, 2006. Reduction in infection with P. falciparum one year after the introduction of malaria control interventions on Bioko Island, Equatorial Guinea. Am J Trop Med Hyg 74 : 972–978.
  15. Sharp BL, Ridl FC, Govender D, Kuklinski J, Kleinschmidt I, 2007. Malaria vector control by indoor residual insecticide spraying on the tropical island of Bioko, Equatorial Guinea. Malar J 6 : 52.
  16. Kleinschmidt I, Torrez M, Schwabe C, Benavente L, Seocharan I, Jituboh D, Nseng G, Sharp B, 2007. Factors influencing the effectiveness of malaria control in Bioko Island, Equatorial Guinea. Am J Trop Med Hyg 76 : 1027–1032.
  17. International Monetary Fund, World economic outlook database. Available at: http://imf.org/external/pubs/ft/weo/2005/02/data/index.htm Accessed February 27, 2009.
  18. Summary I, 2009. WHO vaccine preventable diseases: monitoring system. Available at: http://www.who.int/immunization_moni-toring/data/en/index.html. Accessed February 27, 2009.
  19. United Nations Development Programme, 2007. Human Development Report 2007/2008. New York: United Nations Development Programme.
  20. Cano J, Berzosa PJ, Roche J, Rubio JM, Moyano E, Guerra-Neira H, Brochero H, Mico M, Edu M, Benito A, 2004. Malaria vectors in the Bioko Island (Equatorial Guinea): estimation of vector dynamics and transmission intensities. J Med Entomol 41 : 158–161.
  21. Roche J, Ayecaba S, Amela C, Alvar J, Benito A, 1996. Epidemiological characteristics of malaria in Equatorial Guinea. Research and Reviews in Parasitology 56 : 99–104.
  22. Maharaj R, Casimiro S, Mthembu SD, Sharp BL, 2004. The residual life of bendiocarb: a field-based evaluation from Mozambique. J Med Entomol 41 : 130–132.
  23. World Health Organization, 2005. Malaria indicator survey: basic documentation for survey design and implementation. Roll Back Malaria Monitoring and Evaluation Reference Group. Available at: http://www.rbm.who.int/merg.html#MIS. Accessed August 4, 2008.
  24. MEASURE DHS, Macro International. Demographic and health surveys. Available at: http://www.measuredhs.com/aboutsurveys/dhs/questionnaires.cfm#3. Accessed August 6, 2008.
  25. Scott JA, Brogdon WG, Collins FH, 1993. Identification of single specimens of the Anopheles gambiae group by polymerase chain reaction. Am J Trop Med Hyg 49 : 520–529.
  26. Snounou G, Viriyakosol S, Zhu XP, Jarra W, Pinheiro L, do Rosario VE, Thaithong S, Brown KN, 1993. High sensitivity of detection of human malaria parasites by the use of nested polymerase chain reaction. Mol Biochem Parasitol 61 : 315–320.
  27. Schoenfeld D, 1983. Sample size formula for the proportional hazards regression model. Biometrics 39 : 499–503.
  28. Deaton A, 1997. The Analysis of Household Surveys: A Micro-econometric Approach to Development Policy. Washington, DC: World Bank Publications.
  29. Deaton A, Muellbauer J, 1980. Economics and Consumer Behavior. New York: Cambridge University Press.
  30. Deaton A, Case A, 1988. Analysis of Household Expenditures. Living Standards Measurement Study, Working Paper No. 28. Washington, DC: World Bank.
  31. Rao JNK, Scott AJ, 1981. The analysis of categorical data from complex sample surveys: chi-squared tests for goodness of fit and independence in two-way tables. J Am Stat Assoc 76 : 221–230.
  32. StataCorp LP, 1985–2008. Stata Statistical Software: Release 10. College Station, TX: StataCorp LP.
  33. Abdullah S, Adazu K, Masanja H, Diallo D, Hodgson A, Ilboudo-Sanogo E, Nhacolo A, Owusu-Agyei S, Thompson R, Smith T, Binka FN, 2007. Patterns of age-specific mortality in children in endemic areas of sub-Saharan Africa. Am J Trop Med Hyg 77 (Suppl): 99–105.
  34. Black RE, Morris SS, Bryce J, 2003. Where and why are 10 million children dying every year? Lancet 361 : 2226–2234.
  35. World Health Organization, 2004. The World Health Report 2003. Geneva: World Health Organization.
  36. Walker N, Schwartländer B, Bryce J, 2002. Meeting international goals in child survival and HIV/AIDS. Lancet 360 : 284–289.
  37. Countdown Coverage Writing Group, 2008. Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions. Lancet 371 : 1247–1258.

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  • Received : 29 Jan 2009
  • Accepted : 06 Mar 2009

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