Evaluating health interventions : child mortality and insecticide-treated-net distribution programs in sub-Saharan Africa

Abstract

Because of the wide-spread and devastating effects of malaria in sub- Saharan Africa, the U.S. launched a $1.2 billion initiative to rapidly scale- up malaria prevention and treatment interventions in high-burden coun- tries in sub-Saharan Africa through the President's Malaria Initiative. One of the main mechanisms used to reduce child mortality due to malaria is the free and heavily subsidized distribution of insecticide-treated bed nets (ITNs). This paper evaluates the effect of such campaigns in Rwanda, Senegal, Uganda, and Zimbabwe using an estimator that exploits the fact that the intervention only affects mortality through a behaviour change from not using ITNs to using ITNs. I find that Rwanda sees a significant decrease in mortality for children under two years of age, but that no ef- fect can be seen for Senegal, Uganda, and Zimbabwe. Through a series of plausibility and falsification tests, I find that the estimators for all coun- tries except Zimbabwe fulfil the assumptions of the model. Therefore, no decrease in mortality for children under two can be seen from these ITN interventions in Uganda and Senegal. A decrease of 7.9 deaths in children under three per 1,000 live births per year is reported for Rwanda.