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US Aid to Combat Malaria in Africa Associated with Reduced Risk of Childhood Mortality

June 16, 2017
Gillings School of Global Public Health

Funding from the United States President’s Malaria Initiative (PMI) in 19 sub-Saharan African countries was associated with a 16 percent reduction in the annual risk of children dying before age five, according to a new study by researchers at the University of North Carolina at Chapel Hill Gillings School of Global Public Health.

Aleksandra Jakubowski, doctoral student in the Department of Health Policy and Management at the Gillings School, is first author of the study, published June 13 in PLOS Medicine. Harsha Thirumurthy, associate professor of health policy and management, is senior author.

Jakubowski and colleagues analyzed large, population-representative data from the 19 countries aided by the PMI and from 13 other sub-Saharan countries that did not receive PMI funding.

Launched in 2005, the PMI provides monetary and technical assistance to ameliorate the high child-mortality rate resulting from malaria. Researchers utilized data for about 10 years before and after the launch, from 1995 to 2014. They found that the introduction of the PMI was associated with a 16 percent average reduction in annual risk of mortality among children aged below 5 years – a large and meaningful decline. The estimated decline in children mortality rates associated with the initiative also grew larger over time.

“Our analyses showed that the reductions in child mortality rates in PMI countries well exceeded the reductions observed in other countries in Africa,” Jakubowski said. “This finding persisted in various analyses that controlled for other types of funding that countries received for malaria prevention and treatment, including from sources such as The Global Fund. Furthermore, our main study finding was confirmed using a per-capita dollar amount of PMI disbursements, which accounted for different scale and intensity of PMI activities between countries and within countries over time.”

PMI funding also was associated with more people in the country having access to key malaria prevention interventions such as insecticide-treated nets and indoor application of insecticide, as well as malaria treatment. Jakubowski and colleagues believe that the improved population coverage of these key malaria interventions in PMI countries were the likely reason for the significant reductions in child mortality.

The authors note that during times when cuts to foreign aid are likely, independent evaluations such as this study can and should be used to assess the value and impact of foreign aid programs.

“This study is an excellent example of how publicly available, population-representative data can be used to understand the likely impacts of major policy initiatives on important health outcomes,” Thirumurthy said. “The large reductions in child mortality in Africa that we attribute to PMI suggest that this program is one that deserves continued support.”

In an accompanying commentary in the journal, Eran Bendavid, assistant professor of internal medicine at Stanford University, wrote that saving young children from preventable deaths in these countries promotes more stable and prosperous societies.

“In countries where the U.S. gives most for health,” he wrote, “the perception of the U.S. is among the most favorable in the world. [The study] underscores that the anticipated benefits of effective aid include not only a reduction in the number of children dying in poor countries, but also, arguably, an investment in the well-being of Americans.”

Other Gillings School co-authors are Sally C. Stearns, professor of health policy and management, and Gustavo Angeles, research assistant professor of maternal and child health. Margaret E. Kruk, associate professor of global health at the Harvard T.H. Chan School of Public Health, is also a co-author.


Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or

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