Fig. 2

Conceptual framework for an adequacy and plausibility assessment supporting Mali malaria impact evaluation [5]. This evaluation is based on the premise that in high-burden countries, malaria constitutes a sizeable percentage of child mortality, such that improvements in the coverage of malaria control interventions (ITN, IRS, IPTp, case management) should result in a subsequent decline in ACCM. This ‘plausibility argument’ is the current standard for measuring the impact of scale up of malaria control over the past decade. Using ACCM as the primary outcome indicator ensures a robust measure that encompasses both direct and indirect malaria-related mortality. As the association between malaria control interventions and ACCM is mediated by malaria-specific outcomes, this evaluation also includes analyses of several measures of malaria-associated morbidity. Malaria infections and severe anaemia are both outcomes on the causal pathway between malaria control intervention coverage and ACCM. Available morbidity data include prevalence of severe anaemia and of malaria parasitaemia in children. Trends in potential contextual factors influencing the changes in ACCM were also explored