Journal Article

The impact of an insecticide treated bednet campaign on all-cause child mortality: A geospatial impact evaluation from the Democratic Republic of Congo

Date Published

Feb 22, 2019

Authors

Carrie Dolan, Ariel BenYishay, Karen Grépin, Jeffery Tanner, April Kimmel, David Wheeler, Gordon McCord

Publisher

PLOS One

Citation

Dolan, C.B., BenYishay, A., Grépin, K.A., Tanner, J.C., Kimmel, A.D, Wheeler, D.C., & McCord, G.C. (2019). The impact of an insecticide treated bednet campaign on all-cause child mortality: A geospatial impact evaluation from the Democratic Republic of Congo. PLOS ONE 14(2): e0212890. https://doi.org/10.1371/journal.pone.0212890

Announcement

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.

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Carrie Dolan

Carrie Dolan

Assistant Professor of Kinesiology and Health Sciences at the College of William & Mary

Ariel BenYishay
Research & Evaluation

Ariel BenYishay

Chief Economist, Director of Research and Evaluation

Karen Grépin

Karen Grépin

Associate Professor of Health Sciences at Wilfrid Laurier University

Gordon McCord

Gordon McCord

Assistant Professor of Economics at the School of Global Policy & Strategy at the University of California, San Diego