Evaluation of Mortality Impact of Mass Disease-Prevention Efforts: A Case of Nationwide Distribution of Insecticide-Treated Nets In Togo, West Africa

Kanako Ishida, U.S. Centers for Disease Control and Prevention (CDC)
Paul Stupp, U.S. Centers for Disease Control and Prevention (CDC)
Howard Gordberg, U.S. Centers for Disease Control and Prevention (CDC)
Marcy Erskine, Canadian Red Cross
Kodjo Morgah, Independent consultant

Evaluation of the mortality impact of a national-scale disease-prevention intervention is complicated by the endogeneity—those individuals who receive the intervention may be healthier than those who did not. This population-based study assesses the mortality impact of Togo’s 2004 nationwide child health campaign that distributed insecticide-treated nets (ITNs) to mothers of children ages 9–59 months. We first demonstrate that a one-time campaign that restricts programme eligibility to households with a surviving child inadvertently excludes some households with a high child-mortality risk, by comparing mortality rates before and after the campaign according to a household’s eligibility status. We then estimate a two-equation model for ITN receipt and mortality risk in order to address the potential endogeneity of ITN receipt. Results show that among households with a child eligible to receive an ITN, living in a household with ITNs significantly reduced mortality among children ages 20–59 months even after controlling for endogeneity.