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01.12.2012 | Research | Ausgabe 1/2012 Open Access

Malaria Journal 1/2012

From intervention to impact: modelling the potential mortality impact achievable by different long-lasting, insecticide-treated net delivery strategies

Malaria Journal > Ausgabe 1/2012
Lucy C Okell, Lucy Smith Paintain, Jayne Webster, Kara Hanson, Jo Lines
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1475-2875-11-327) contains supplementary material, which is available to authorized users.
Lucy C Okell, Lucy Smith Paintain contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

JL, LSP, JW and KH devised the study design and objectives. LO developed the model. LO, LSP, JL, JW and KH contributed to parameterization, analysis and interpretation. LSP and LO wrote the first draft of the manuscript. All authors read, commented on and approved the final manuscript.



The current target of universal access to long-lasting, insecticide-treated nets (LLIN) is 80% coverage to reduce malaria deaths by 75% by 2015. So far, campaigns have been the main channel for large-scale delivery of LLINs, however the World Health Organization has recommended that equal priority should be given to delivery via routine antenatal care (ANC) and immunization systems (EPI) to target pregnant women and children from birth. These various channels of LLIN delivery are targeted to children of different ages. Since risk of mortality varies with child age and LLIN effectiveness declines with net age, it was hypothesized that the age at which a child receives a new LLIN, and therefore the delivery channel, is important in optimizing the health impact of a net.


A simple dynamic mathematical model was developed of delivery and impact of LLINs among children under five years of age and their household members, incorporating data on age-specific malaria death rates, net use by household structure, and net efficacy over time.


The presented analysis finds that supplementing a universal mass campaign with extra ANC delivery would achieve a 1.4 times higher mortality reduction than campaign delivery alone, reflecting that children born in the years between campaigns would otherwise have access to old nets or no nets at an age of high risk. The relative advantage of supplementary ANC delivery is still present though smaller if malaria transmission levels are lower or if there is a strong mass effect achieved by mass campaigns.


These results indicate that LLIN delivery policies must take into account the age of greatest malaria risk. Emphasis should be placed on supporting routine delivery of LLINs to young children as well as campaigns.
Additional file 1: Supplementary information on parameter assumptions and data sources.(DOCX 178 KB)
Authors’ original file for figure 1
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