Funded investments contributed to the reduction of malaria morbidity and mortality in children under five: fifteen years retrospective study from 2009 to 2023 in Burkina Faso

BACKGROUND: Many countries worldwide, particularly those in sub-Saharan Africa, suffer from malaria burden, both mortality and morbidity. Multiple funding agencies are investing to improve the health of populations. The aim of this study was to assess the impact of malaria funding on mortality and morbidity in children under 5 years of age over a 15-year period. METHODS: A retrospective study was conducted from 2009 to 2023 across the country. Analysis was based on a secondary analysis of routine data from health facilities via DHIS2. Financial data was assembled from the malaria programme and health accounts. RESULTS: Between 2009 and 2023, Burkina Faso's population grew by 50.7%, from 15.2 to 22.9 million. Children under 5 represented 19.1% of the population in 2009 and 17.9% in 2023 and increased in number by 41.4%. In fifteen years, Burkina Faso invested USD13,545 million in the health sector, including 15.3% against malaria. These efforts yielded several benefits in health services including: the reduction of distance travelled by the population to health facilities from 7.2 to 6.0 km; the number of new contacts per capita for children under 5 per year increased from 0.8 to 2.1; the malaria case fatality rate decreased from 3.4% to 1.3% in children under 5. Stratified analysis identified three regions out of thirteen [Sahel (IRR = 4.1), Boucle du Mouhoun (IRR = 3.5) and Nord (IRR = 3.4), where the risk of malaria mortality was three times higher than in the Centre. CONCLUSION: The study demonstrated the impact of funding on malaria morbidity and mortality, and diverse local risk of death from malaria in children under 5.