The effect of insecticide-treated bed nets on the incidence and prevalence of malaria in children in an area of unstable seasonal transmission in western Myanmar

Malaria Journal

Case Study

Piet A Kager¹  Kasia Stepniewska²  Julie A Simpson³  Yoel Lubell⁴  Nicholas J White⁴  Nina Katterman⁵  Frank M Smithuis⁶  U Ohn Phe⁶  Patrick Almeida⁷  Colin Rogers⁷  Ingrid van der Broek⁷  Moe Kyaw Kyaw⁷ 

[1] Centre for Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, Amsterdam, The Netherlands;Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 3rd Floor, 60th Anniversary Chalermprakiat Building, 420/6 Rajvithi Rd., 10400, Ratchathewi District, Bangkok, Thailand;Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 3rd Floor, 60th Anniversary Chalermprakiat Building, 420/6 Rajvithi Rd., 10400, Ratchathewi District, Bangkok, Thailand;Centre for Molecular, Environmental, Genetic & Analytic Epidemiology, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia;Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 3rd Floor, 60th Anniversary Chalermprakiat Building, 420/6 Rajvithi Rd., 10400, Ratchathewi District, Bangkok, Thailand;Centre for Tropical Medicine, CCVTM, Churchill Hospital, Oxford, UK;Medical Action Myanmar, Kokkine Swimming Club Lane, 32A1, Yangon, Myanmar;Medical Action Myanmar, Kokkine Swimming Club Lane, 32A1, Yangon, Myanmar;Médécins sans Frontières Holland, Thanlin Road 62A, Yangon, Myanmar;Médécins sans Frontières Holland, Thanlin Road 62A, Yangon, Myanmar;

关键词: Malaria;    P. falciparum;    P. vivax;    Insecticide treated bed nets;    Entomology;    Biting time;    Myanmar;    Cost-effectiveness;    Cluster randomized controlled trial;   

DOI  :  10.1186/1475-2875-12-363

 received in 2013-06-24, accepted in 2013-09-20,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundInsecticide-treated bed nets (ITN) reduce malaria morbidity and mortality consistently in Africa, but their benefits have been less consistent in Asia. This study’s objective was to evaluate the malaria protective efficacy of village-wide usage of ITN in Western Myanmar and estimate the cost-effectiveness of ITN compared with extending early diagnosis and treatment services.MethodsA cluster-randomized controlled trial was conducted in Rakhine State to assess the efficacy of ITNs in preventing malaria and anaemia in children and their secondary effects on nutrition and development. The data were aggregated for each village to obtain cluster-level infection rates. In total 8,175 children under 10 years of age were followed up for 10 months, which included the main malaria transmission period. The incidence and prevalence of Plasmodium falciparum and Plasmodium vivax infections, and the biting behaviour of Anopheles mosquitoes in the area were studied concurrently. The trial data along with costs for current recommended treatment practices were modelled to estimate the cost-effectiveness of ITNs compared with, or in addition to extending the coverage of early diagnosis and treatment services.ResultsIn aggregate, malaria infections, spleen rates, haemoglobin concentrations, and weight for height, did not differ significantly during the study period between villages with and without ITNs, with a weighted mean difference of −2.6 P. falciparum episodes per 1,000 weeks at risk (95% Confidence Interval −7 to 1.8). In areas with a higher incidence of malaria there was some evidence ITN protective efficacy. The economic analysis indicated that, despite the uncertainty and variability in their protective efficacy in the different study sites, ITN could still be cost-effective, but not if they displaced funding for early diagnosis and effective treatment which is substantially more cost-effective.ConclusionIn Western Myanmar deployment of ITNs did not provide consistent protection against malaria in children living in malaria endemic villages. Early diagnosis and effective treatment is a more cost effective malaria control strategy than deployment of ITNs in this area where the main vector bites early in the evening, often before people are protected by an ITN.

【 授权许可】

Unknown   
© Smithuis et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.