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01.12.2017 | Research | Ausgabe 1/2017 Open Access

Malaria Journal 1/2017

Effects of community-level bed net coverage on malaria morbidity in Lilongwe, Malawi

Zeitschrift:
Malaria Journal > Ausgabe 1/2017
Autoren:
Veronica Escamilla, Alisa Alker, Leonard Dandalo, Jonathan J. Juliano, William C. Miller, Portia Kamthuza, Tapiwa Tembo, Gerald Tegha, Francis Martinson, Michael Emch, Irving F. Hoffman
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12936-017-1767-2) contains supplementary material, which is available to authorized users.

Abstract

Background

The protective effect of insecticide-treated bed nets against individual-level malaria transmission is well known, however community-level effects are less understood. Protective effects from community-level bed net use against malaria transmission have been observed in clinical trials, however, the relationship is less clear outside of a controlled research setting. The objective of this research was to investigate the effect of community-level bed net use against malaria transmission outside of a bed net clinical trial setting in Lilongwe, Malawi following national efforts to scale-up ownership of long-lasting, insecticide-treated bed nets.

Methods

An annual, cross-sectional, household-randomized, malaria transmission intensity survey was conducted in Lilongwe, Malawi (2011–2013). Health, demographic, and geographic-location data were collected. Participant blood samples were tested for Plasmodium falciparum presence. The percentage of people sleeping under a bed net within 400-m and 1-km radii of all participants was measured. Mixed effects logistic regression models were used to measure the relationship between malaria prevalence and surrounding bed net coverage. Each year, 800 people were enrolled (400 <5 years; 200 5–19 years; 200 ≥20 years; total n = 2400).

Results

From 2011 to 2013, malaria prevalence declined from 12.9 to 5.6%, while bed net use increased from 53.8 to 78.6%. For every 1% increase in community bed net coverage, malaria prevalence decreased among children under 5 years old [adjusted odds ratio: 0.98 (0.96, 1.00)]. Similar effects were observed in participants 5–19 years [unadjusted odds ratio: 0.98 (0.97, 1.00)]; the effect was attenuated after adjusting for individual-level bed net use. Community coverage was not associated with malaria prevalence among adults ≥20 years. Supplemental analyses identified more pronounced indirect protective effects from community-level bed net use against malaria transmission among children under 5 years who were sleeping under a bed net [adjusted odds ratio: 0.97 (0.94, 0.99)], compared to children who were not sleeping under a bed net [adjusted odds ratio: 0.99 (0.97, 1.01)].

Conclusions

Malawi’s efforts to scale up ownership of long-lasting, insecticide-treated bed nets are effective in increasing reported use. Increased community-level bed net coverage appears to provide additional protection against malaria transmission beyond individual use in a real-world context.
Zusatzmaterial
Additional file 1. Mixed effects logistic regression results for children under 5 years stratified by bed net use.
Additional file 2. Predicted margins with 95% confidence interval of Plasmodium falciparum infection in children <5 years old for per cent increase in bed net coverage within 400-m. a Children <5 years who sleep under a bed net; b children <5 years who do not sleep under a bed net.
Literatur
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