the area of HIV prevention, for example, the number of USAID-assisted counseling and testing centers increased from 3 in 2000 to 276 in 2007, while the number of clients assisted at these sites per year increased from about 22,000 in 2000 to more than 192,000 in 2007. In addition, according to a national Demographic and Health Survey (DHS) completed in 2005 with support from USAID, USAID's Presidential Emergency Plan for HIV/AIDS Relief activities reached 1,351,404 people through ABC messages (abstinence from sexual activity, being faithful to a single partner, and correct and consistent condom use) and provided care to 57,356 HIV/AIDS orphans and vulnerable children. Under-five mortality rates declined from a high of 189 per thousand live births in 2000 to 133 per thousand live births in 2004; the total fertility rate (TFR) declined to 6 children per woman, and the proportion of Malawian children sleeping under an insecticide-treated bed nets (ITN) (26% in 2004) was more than three times the proportion (8%) sleeping under an ITN in 2000. Key achievements in 2007 under the Presidential Malaria Initiative (PMI) included: the distribution of 185,400 long-lasting insecticide-treated mosquito nets and 2,607,480 doses of a new life-saving drug delivered nationwide. Improving the quality and efficiency of basic education remain the major development challenges in the Malawi education system. USAID continues to fund activities that target quality of and access to the primary education sub-sector level, which is having a positive effect at both the local and national levels. At the local level, USAID-funded activities are helping communities and parents make more informed decisions to improve the quality of primary schooling. In 2007, USAID continued its efforts in the education sector through (1) development of teachers' professional skills through long-term undergraduate and graduate training in Malawi and the U.S.; (2) reinforcement of innovative classroom practices through pre-service and in-service teacher training; (3) participation of communities and teacher training colleges in HIV/AIDS outreach activities; (4) support of Government of Malawi adoption of key policy reforms in teacher education and HIV/AIDS; and (5) improving the quality and quantity of data available for policymaking. In 2007, USAID, through the African Education Initiative (AEI) and congressionally mandated School Fees Initiative (SFI), improved the quality of and access to primary education for 624,032 children and enhanced the pedagogical skills of 10,355 teachers. The United States is the largest contributor to the World Food Program (WFP) in Malawi, providing