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PMI: Presidents Malaria Initiative - Saving lives in Africa.

PMI Results

Family hanging mosquito net.
A volunteer in Tanzania helps a family hang a long-lasting insecticide-treated net they received through a net distribution campaign.
Source: Dan Albrecht/MEDA Tanzania

Over the past five years, substantial reductions have been recorded in all-cause mortality in children under five years of age. These findings are buttressed by equally impressive improvements in malaria-specific indicators in all PMI-supported countries where baseline and follow-up nationwide household surveys have been conducted. The reductions in mortality are associated with a dramatic scale-up of malaria prevention and treatment measures since 2005, thanks to the collective efforts of national governments; the U.S. Government; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Bank; other international donors; and multilateral and nongovernmental organizations.

This page presents activities and results that represent the effect of the first four years of PMI funding (fiscal years 2006–2009) or approximately 60 percent of the $1.265 billion requested for the Initiative. For more details, please access The PMI Fifth Annual Report, April 2011 [PDF, 6MB].

Progress After Five Years of Implementation

PMI Contributions at a Glance. Indicator^1, Year 1 (2006), Year 2 (2007), Year 3 (2008), Year 4 (2009), Year 5 (2010), Cumulative. Indicator row 1: People protected by IRS (houses sprayed), Year 1 (2006) row 1: 2,097,056 (414,456), Year 2 (2007) row 1: 18,827,709 (4,353,747), Year 3 (2008) row 1: 25,157,408 (6,101,271), Year 4 (2009) row 1: 26,965,164 (6,656,524), Year 5 (2010) row 1: 27,199,063 (6,693,218), Cumulative: N/A^2. Indicator row 2: ITNs procured, Year 1 (2006) row 2: 1,047,393, Year 2 (2007) row 2: 5,210,432, Year 3 (2008) row 2: 6,481,827, Year 4 (2009) row 2: 15,160,302, Year 5 (2010) row 2: 17,532,839, Cumulative row 2: 45,432,793 (30,343,517 distributed). Indicator row 3: ITNs procured by other donors and distributed with PMI support, Year 1 (2006) row 3: blank, Year 2 (2007) row 3: 369,900, Year 3 (2008) row 3: 1,287,624, Year 4 (2009) row 3: 2,966,011, Year 5 (2010) row 3: 10,856,994, Cumulative row 3: 15,480,529. Indicator row 4: IPTp treatments procured, Year 1 (2006) row 4: blank, Year 2 (2007) row 4: 583,333, Year 3 (2008) row 4: 1,784,999, Year 4 (2009) row 4: 1,657,998, Year 5 (2010) row 4: 6,264,752, Cumulative row 4: 10,291082 (5,084,185 distributed)^3. Indicator row 5: Health workers trained in IPTp/focused antenatal care, Year 1 (2006) row 5: 1,994, Year 2 (2007) row 5: 3,153, Year 3 (2008) row 5: 12,557, Year 4 (2009) row 5: 14,015, Year 5 (2010) row 5: 14,146^4, Cumulative row 5: N/A^5. Indicator row 6: Rapid diagnostic tests procured, Year 1 (2006) row 6: 1,004,875, Year 2 (2007) row 6: 2,082,600, Year 3 (2008) row 6: 2,429,000, Year 4 (2009) row 6: 6,254,000, Year 5 (2010) row 6: 13,340,110, Cumulative row 6: N/A^5. Indicator row 7: Health workers trained in malaria diagnosis (RDTs and/or microscopy), Year 1 (2006) row 7: blank, Year 2 (2007) row 7: 1,370, Year 3 (2008) row 7: 1,663, Year 4 (2009) row 7: 2,856, Year 5 (2010) row 7: 17,335, Cumulative row 7: N/A^5. Indicator row 8: ACT treatments procured, Year 1 (2006) row 8: 1,229,550, Year 2 (2007) row 8: 8,851,820, Year 3 (2008) row 8: 22,354,139, Year 4 (2009) row 8: 21,833,155, Year 5 (2010) row 8: 41,048,295, Cumulative row 8: 95,316,959 (67,509,272 distributed)^3. Indicator row 9: ACT treatments procured by other donors and distributed with PMI support, Year 1 (2006) row 9: blank, Year 2 (2007) row 9: 8,709,140, Year 3 (2008) row 9: 112,330, Year 4 (2009) row 9: 8,855,401, Year 5 (2010) row 9: 3,536,554, Cumulative row 9: 21,213,425. Indicator row 10: Health workers trained in case management, Year 1 (2006) row 10: 8,344, Year 2 (2007) row 10: 20,864, Year 3 (2008) row 10: 35,397, Year 4 (2009) row 10: 41,273, Year 5 (2010) row 10: 36,458, Cumulative row 10: N/A^5. Footnote 1: Data reported in this table are up to date as of January 1, 2011, and include 15 PMI focus countries, plus jump-start activities in DRC and Nigeria. In addition, during 2010, the USG provided support for malaria prevention and control activities in other countries. For data by country, see Appendix 2. With this 2011 report, some adjustments were made to previous years’ procurement figures in order to reconcile quantities of commodities procured by each country in a given calendar year with the figures reported by implementing partners responsible for those procurements. These changes represent less than 2 percent of the total procurements for commodities. Footnote 2: A cumulative count of people protected by IRS is not provided because most areas are sprayed on more than one occasion. Footnote 3: Distributed to health facilities. Footnote 4: This total includes 964 health workers who were trained in focused antenatal care in Rwanda, where IPTp is not national policy. Footnote 5: A cumulative count of health workers trained in not provided because some health workers have been trained on more than one occasion.

Impact on Malaria and Mortality in Children Under Five Years of Age

Seven PMI focus countries have had at least two nationwide surveys that measured all-cause mortality in children under the age of five (see below). These surveys reported reductions in mortality rates ranging from 23 to 36 percent. In Tanzania, where a third data point is available from a 2010 nationwide survey, under-five mortality fell an additional 11 percent from the 2007 level. Similar reductions in other measures of malaria burden, such as the prevalence of malaria infections and severe anemia in young children, are also being documented.

Although it is not possible to measure malaria-related deaths in such surveys directly, and multiple factors may be influencing the decline in under-five mortality rates, strong and growing evidence suggests malaria prevention and treatment are playing major roles in these unprecedented reductions in malaria burden.

Reductions in All-Cause Mortality Rates of Children Under Five. Y-axis: Deaths per 1,000 Live Births. X-axis: Ghana, Kenya, Madagascar, Rwanda, Senegal, Tanzania, Zambia. Ghana 2003-2006: 111 deaths per 1,000 live births, Ghana 2007-2009: 80 deaths per 1,000 live births, Kenya 2003-2006: 115 deaths per 1,000 live births, Kenya 2007-2009 74 deaths per 1,000 live births, Madagascar 2003-2006: 94 deaths per 1,000 live births, Madagascar 2007-2009: 72 deaths per 1,000 live births, Rwanda 2003-2006: 152 deaths per 1,000 live births, Rwanda 2007-2009: 103 deaths per 1,000 live births, Senegal 2003-2006: 121 deaths per 1,000 live births, Senegal 2007-2009: 85 deaths per 1,000 live births, Tanzania 2003-2006: 112 deaths per 1,000 live births, Tanzania 2007-2009: 91 deaths per 1,000 live births, Tanzania 2010: 81 deaths per 1,000 live births, Zambia 2003-2006: 168 deaths per 1,000 live births, Zambia 2007-2009: 119 deaths per 1,000 live births. Note: The countries included in this figure have at least two data points from nationwide household surveys that measured mortality in children under the age of five. These data are drawn from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and in a small number of cases, from Malaria Indicator Surveys with expanded sample sizes.

The country examples described below are characteristic of what is being seen in all seven PMI countries that have mortality data.

  • In Tanzania, all-cause under-five mortality fell by 28 percent between 2005 and 2010. Over the same time period, household ownership of at least one insecticide-treated net (ITN) increased from 23 to 64 percent, and ITN use among children under five years of age and pregnant women increased from 16 percent (both groups) to 64 percent and 57 percent, respectively. In addition, nationwide prevalence of severe anemia in children six months to five years of age also fell by 50 percent between 2005 and 2010. Malaria control has been particularly successful on the island of Zanzibar, where less than 2 percent of patients at the 90 health facility surveillance sites that make up Zanzibar’s malaria epidemic early detection system now have blood smears positive for malaria parasites.

  • In Senegal, a 30 percent reduction in all-cause mortality in children under five was documented between 2005 and 2008. Although several factors may be involved, it is highly likely that this dramatic reduction is due, at least in part, to rapid increases in the coverage of malaria interventions. Household ownership of one or more ITNs increased from 36 percent in 2006 to 60 percent in 2008. After the 2009 national ITN distribution to children under age five, a post-campaign survey found household ITN ownership had increased to 82 percent. The proportion of pregnant women who received two or more doses of intermittent preventive treatment for pregnant women (IPTp) rose from 12 to 52 percent between 2005 and 2008. Although no national-level baseline data are available for comparison, less than 6 percent of children under age five had malaria parasites in the 2008 nationwide survey, a level much lower than the 20 to 60 percent levels seen in longitudinal studies in Senegal.

Insecticide-Treated Net Ownership and Use

PMI focus countries have made rapid progress in scaling up ITN ownership. In the nine countries that have baseline and follow-up household surveys, ownership has increased significantly since PMI’s launch, from an average of 31 percent in baseline surveys to an average of 61 percent in more recent surveys (see below).

Increasing ITN Ownership. Y-axis: % Households ITN Ownership. X-axis: Ghana, Kenya, Madagascar, Rwanda, Senegal, Tanzania, Zambia. Ghana 2004-2006: 19% of households own ITN, Ghana 2007-2009: 33% of households own ITN, Kenya 2004-2006: 48% of households own ITN, Kenya 2007-2009: 56% of households own ITN, Malawi 2004-2006: 38% of households own ITN, Malawi 2010: 58% of households own ITN, Mali 2004-2006: 50% of households own ITN, Mali 2010: 85% of households own ITN, Rwanda 2004-2006: 15% of households own ITN, Rwanda 2007-2009: 56% of households own ITN, Senegal 2004-2006: 36% of households own ITN, Senegal 2007-2009: 82% of households own ITN, Tanzania 2004-2006: 23% of households own ITN, Tanzania 2007-2009: 39% of households own ITN, Tanzania 2010: 64% of households own ITN, Uganda 2004-2006: 16% of households own ITN, Uganda 2007-2009: 47% of households own ITN, Zambia 2004-2006: 38% of households own ITN, Zambia 2007-2009: 62% of households own ITN, Zambia 2010: 64% of households own ITN. Note: The PMI focus countries included in this graph have at least two data points for the indicator from nationwide household surveys (Demographic and Health Surveys or Malaria Indicator Surveys).

Across the 15 original PMI focus countries, the percentage of families owning at least one ITN increased from less than 10 percent to greater than 50 percent (see below).

Percentage of Households with at Least One ITN in 15 PMI Countries

Percentage of Households with at Least One ITN in 15 PMI Countries. Two maps, one map from 1999-2004 and the other from 2005-2010 highlighting households with at least one ITN ranging from 0-100% across Africa.

Note: DRC and Nigeria are not included on these maps because PMI activities started in those countries in 2010.

Household surveys also show that ITN use among children under five years of age and pregnant women has increased significantly. Use among children under five (see below) rose from an average of 21 percent in baseline surveys to an average of 50 percent in more recent surveys, while use by pregnant women rose from 18 to 47 percent.

Increasing ITN Use among Children Under Five. Y-axis: % ITN Use among Children Under Five. X-axis: Ghana, Kenya, Madagascar, Rwanda, Senegal, Tanzania, Zambia. Ghana 2004-2006: 22% ITN use among children under five, Ghana 2007-2009: 28% ITN use among children under five, Kenya 2004-2006: 39% ITN use among children under five, Kenya 2007-2009: 47% ITN use among children under five, Malawi 2004-2006: 25% ITN use among children under five, Malawi 2010: 55% ITN use among children under five, Mali 2004-2006: 25% ITN use among children under five, Mali 2010: 70% ITN use among children under five, Rwanda 2004-2006: 13% ITN use among children under five, Rwanda 2007-2009: 57% ITN use among children under five, Senegal 2004-2006: 16% ITN use among children under five, Senegal 2007-2009: 46% ITN use among children under five, Tanzania 2004-2006: 16% ITN use among children under five, Tanzania 2007-2009: 26% ITN use among children under five, Tanzania 2010: 64% ITN use among children under five, Uganda 2004-2006: 10% ITN use among children under five, Uganda 2007-2009: 33% ITN use among children under five, Zambia 2004-2006: 24% ITN use among children under five, Zambia 2007-2009: 41% ITN use among children under five, Zambia 2010: 50% ITN use among children under five.

Malaria in Pregnancy Coverage

The proportion of pregnant women who have received at least one IPTp dose during their last pregnancy has increased rapidly across Africa since 2004. However, the percentage of pregnant women who receive at least two doses of IPTp (IPTp2) is lagging behind. In spite of this, eight PMI countries have reported increases in IPTp2 from their baseline nationwide household surveys, rising from an average of 24 percent in baseline surveys to an average of 43 percent in more recent surveys.

Increasing IPTp2 Rates. Y-axis: % Pregnant Women Who Received IPTp2. X-axis: Ghana, Kenya, Madagascar, Rwanda, Senegal, Tanzania, Zambia. Ghana 2003-2006: 25% pregnant women who received IPTp2, Ghana 2007-2009: 14% pregnant women who received IPTp2, Kenya 2003-2006: 13% pregnant women who received IPTp2, Kenya 2007-2009: 14% pregnant women who received IPTp2, Liberia 2003-2006: 4% pregnant women who received IPTp2, Liberia 2007-2009: 45% pregnant women who received IPTp2, Malawi 2003-2006: 43% pregnant women who received IPTp2, Malawi 2007-2009: 60% pregnant women who received IPTp2, Senegal 2003-2006: 12% pregnant women who received IPTp2, Senegal 2007-2009: 52% pregnant women who received IPTp2, Tanzania 2003-2006: 21% pregnant women who received IPTp2, Tanzania 2007-2009: 30% pregnant women who received IPTp2, Tanzania 2010: 26% pregnant women who received IPTp2, Uganda 2003-2006: 16% pregnant women who received IPTp2, Uganda 2007-2009: 32% pregnant women who received IPTp2, Zambia 2003-2006: 57% pregnant women who received IPTp2, Zambia 2007-2009: 60% pregnant women who received IPTp2, Zambia 2010: 69% pregnant women who received IPTp2. Note: The PMI focus countries included in this graph have at least two data points for the indicator from nationwide household surveys (Demographic and Health Surveys or Malaria Indicator Surveys). IPTp2 is defined as at least two doses of SP during the last pregnancy, with at least one dose given during an antenatal clinic visit.

Results presented on this page are up-to-date as of January 1, 2011.

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