Document Type
Article
Department/Program
Kinesiology & Health Sciences
Journal Title
PLoS ONE
Pub Date
2-22-2019
Publisher
PLoS
Volume
14
Issue
2
Abstract
Objective
To test the impact of a nationwide Long-Lasting Insecticidal Nets [LLINs] distribution program in the Democratic Republic of Congo [DRC] on all-cause under-five child mortality exploiting subnational variation in malaria endemicity and the timing in the scale-up of the program across provinces.
Design
Geospatial Impact Evaluation using a difference-in-differences approach.
Setting
Democratic Republic of the Congo.
Participants
52,656 children sampled in the 2007 and 2013/2014 DRC Demographic and Health Surveys.
Interventions
The analysis provides plausibly causal estimates of both average treatment effects of the LLIN distribution campaign and geospatial heterogeneity in these effects based on malaria endemicity. It compares the under-five, all-cause mortality for children pre- and post-LLIN campaign relative to children in those areas that had not yet been exposed to the campaign using a difference-in-differences model and controlling for year- and province-fixed effects, and province-level trends in mortality.
Results
We find that the campaign led to a 41% decline [3.7 percentage points, 95% CI 1.3 to 6.0] in under-5 mortality risk among children living in rural areas with malaria ecology above the sample median. Results were robust to controlling for household assets and the presence of other health aid programs. No effect was detected in children living in areas with malaria ecology below the median.
Conclusion
The findings of this paper make important contributions to the evidence base for the effectiveness of large scale-national LLIN campaigns against malaria. We found that the program was effective in areas of the DRC with the highest underlying risk of malaria. Targeting bednets to areas with greatest underlying risk for malaria may help to increase the efficiency of increasingly limited malaria resources but should be balanced against other malaria control concerns.
Recommended Citation
Dolan, Carrie B.; BenYishay, Ariel; Grepin, Karen A.; and Tanner, Jeffery C., The impact of an insecticide treated bednet campaign on all-cause child mortality: A geospatial impact evaluation from the Democratic Republic of Congo (2019). PLoS ONE, 14(2).
https://doi.org/10.1371/journal.pone.0212890
DOI
https://doi.org/10.1371/journal.pone.0212890
