ISSN: 2226-3624
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Despite decades of global investment in malaria control, under-5 mortality in Sub-Saharan Africa (SSA) remains unacceptably high, and the governance conditions under which malaria programmes translate into child survival gains are poorly understood. This study investigates the direct relationship between malaria incidence, institutional quality, and under-5 mortality using a panel of 35 SSA countries from 2000 to 2023 and examines whether institutional quality modifies the malaria-mortality relationship. Applying static Fixed Effects estimation with Driscoll-Kraay standard errors, confirmed through a five-stage diagnostic sequence encompassing cross-sectional dependence testing, second-generation panel unit root tests, Hausman specification testing, dynamic persistence testing, and control-function endogeneity correction, we find that malaria incidence significantly and robustly increases under-5 mortality across all specifications. At mean institutional quality, a one standard deviation increase in malaria incidence is associated with 5.7 additional child deaths per 1,000 live births. Marginal effects analysis indicates a 35% differential in the malaria-mortality relationship between weak and strong governance settings, though the interaction term does not reach conventional statistical significance. Among individual governance dimensions, Government Effectiveness and Regulatory Quality approach significance as moderators, pointing to state operational capacity rather than accountability or stability as the proximate institutional channel. A novel methodological contribution concerns data quality: three transcription errors in a single fragile state account for approximately 23 percentage points of unexplained model variation, illustrating that data quality failures in conflict-affected settings disproportionately influence panel estimates for the entire region. The findings support treating malaria control and institutional capacity-building as complementary rather than competing priorities in SSA health policy.
Bhatt, S., Weiss, D. J., Cameron, E., Bisanzio, D., Mappin, B., Dalrymple, U., Battle, K. E., Moyes, C. L., Henry, A., Eckhoff, P. A., Wenger, E. A., Briët, O., Penny, M. A., Smith, T. A., Bennett, A., Yukich, J., Eisele, T. P., Griffin, J. T., Fergus, C. A., … Gething, P. W. (2015). The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 2015 526:7572, 526(7572), 207–211. https://doi.org/10.1038/nature15535
Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: Coming of age. Annual Review of Public Health, 32(Volume 32, 2011), 381–398. https://doi.org/10.1146/ANNUREV-PUBLHEALTH-031210-101218/CITE/REFWORKS
Driscoll, J. C., & Kraay, A. C. (1998). Consistent Covariance Matrix Estimation with Spatially Dependent Panel Data. The Review of Economics and Statistics, 80(4), 549–560. https://doi.org/10.1162/003465398557825
Farag, M., Nandakumar, A. K., Wallack, S., Hodgkin, D., Gaumer, G., & Erbil, C. (2013). Health expenditures, health outcomes and the role of good governance. International Journal of Health Care Finance and Economics, 13(1), 33–52. https://doi.org/10.1007/S10754-012-9120-3/TABLES/5
Gething, P. W., Smith, D. L., Patil, A. P., Tatem, A. J., Snow, R. W., & Hay, S. I. (2010). Climate change and the global malaria recession. Nature 2010 465:7296, 465(7296), 342–345. https://doi.org/10.1038/nature09098
Greenwood, B. M., Bojang, K., Whitty, C. J., & argett, G. A. (n.d.). Malaria Lancet. 365 (9469)(2005). View PDF View Article View in Scopus, 1487-1498. Retrieved March 27, 2026, from https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Greenwood%2C+B.+M.%2C+Bojang%2C+K.%2C+Whitty%2C+C.+J.%2C+%26+Targett%2C+G.+A.+%282005%29.+Malaria.+The+Lancet%2C+365%289469%29%2C+1487%E2%80%931498.&btnG=
Hafner, T., & Shiffman, J. (2013). The emergence of global attention to health systems strengthening. Health Policy and Planning, 28(1), 41–50. https://doi.org/10.1093/HEAPOL/CZS023
Kaufmann, A., & Kraay, E. (2002). Growth without governance H-Index: 11SJR: Q2 CORE: NA ABDC: C FT50: NA. Economia. https://www.jstor.org/stable/20065434
Kouadio, M. (2025). Effects of governance quality on health outcomes in West African countries. Discover Public Health 2025 22:1, 22(1), 645-. https://doi.org/10.1186/s12982-025-01014-6
Kudamatsu, M., Persson, T., & Strömberg, D. (2012). Weather and Infant Mortality in Africa. Journal of Tropical Pediatrics, 29(1), 50–54. https://doi.org/10.1093/tropej/29.1.50
Langbein, L., & Knack, S. (2010). The worldwide governance indicators: Six, one, or none? Journal of Development Studies, 46(2), 350–370. https://doi.org/10.1080/00220380902952399
Liu, L., Oza, S., Hogan, D., Perin, J., Rudan, I., Lawn, J. E., Cousens, S., Mathers, C., & Black, R. E. (2015). Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: An updated systematic analysis. The Lancet, 385(9966), 430–440. https://doi.org/10.1016/S0140-6736(14)61698-6
Mahapatra, P., Shibuya, K., Lopez, A. D., Coullare, F., Notzon, F. C., Rao, C., & Szreter, S. (2007). Civil registration systems and vital statistics: successes and missed opportunities. Lancet, 370(9599), 1653–1663. https://doi.org/10.1016/S0140-6736(07)61308-7
Olafsdottir, A. E., Reidpath, D. D., Pokhrel, S., & Allotey, P. (2011). Health systems performance in sub-Saharan Africa: governance, outcome and equity. BMC Public Health 2011 11:1, 11(1), 237-. https://doi.org/10.1186/1471-2458-11-237
Rajkumar, A. S., & Swaroop, V. (2008). Public spending and outcomes: Does governance matter? Journal of Development Economics, 86(1), 96–111. https://doi.org/10.1016/J.JDEVECO.2007.08.003
Sachs, J., & Malaney, P. (2002). The economic and social burden of malaria. Nature 2002 415:6872, 415(6872), 680–685. https://doi.org/10.1038/415680a
Setel, P. W., Macfarlane, S. B., Szreter, S., Mikkelsen, L., Jha, P., Stout, S., & AbouZahr, C. (2007). A scandal of invisibility: making everyone count by counting everyone. Lancet, 370(9598), 1569–1577. https://doi.org/10.1016/S0140-6736(07)61307-5
WHO. (2022a). World malaria report. In World Health Organization.
WHO. (2022b). World malaria report . World Health Organization. https://books.google.com.my/books?hl=en&lr=&id=ST-hEAAAQBAJ&oi=fnd&pg=PR6&dq=World+Health+Organization.+(2022).+World+Malaria+Report+2022.+WHO.&ots=YZzWW8Oktm&sig=spl1fxUQziZl1SEmOSbmUFHE8nA&redir_esc=y#v=onepage&q=World%20Health%20Organization.%20(2022).%20World%20Malaria%20Report%202022.%20WHO.&f=false
WHO. (2023). Report of the first and second meetings of the technical advisory group on malaria elimination and certification. https://books.google.com/books?hl=en&lr=&id=naMOEQAAQBAJ&oi=fnd&pg=PR5&dq=World+Malaria+Report+2023%3B+World+Health+Organization:+Geneva,+Switzerland,+2023&ots=bnzVQ1QsAe&sig=LXMMlcXGJFxIF1nhuc-Zs5Hd9hY
Olohunlana, S. D., Ishak, S., Bani, N. Y. M., Olohunlana, A. O., & Abdelrehim, M. M. A. (2026). Malaria and Child Survival in Sub-Saharan Africa: Does Institutional Quality Modify the Malaria-Mortality Relationship? International Journal of Academic Research in Economics and Management Sciences, 15(2), 221-238.
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