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

Malaria Journal

Research

Veronica Escamilla¹  Michael Emch²  Alisa Alker³  William C. Miller⁴  Jonathan J. Juliano⁵  Irving F. Hoffman⁶  Portia Kamthuza⁷  Tapiwa Tembo⁷  Gerald Tegha⁷  Leonard Dandalo⁷  Francis Martinson⁷ 

[1] Carolina Population Center, University of North Carolina, 308 W Rosemary, CB 8120, 27599, Chapel Hill, NC, USA;Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 27599, Chapel Hill, NC, USA;Department of Geography, University of North Carolina, 27599, Chapel Hill, NC, USA;Division of Infectious Diseases, University of North Carolina, 27599, Chapel Hill, NC, USA;Division of Infectious Diseases, University of North Carolina, 27599, Chapel Hill, NC, USA;Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 27599, Chapel Hill, NC, USA;Division of Infectious Diseases, University of North Carolina, 27599, Chapel Hill, NC, USA;Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 27599, Chapel Hill, NC, USA;Curriculum in Genetics and Molecular Biology, University of North Carolina, 27599, Chapel Hill, NC, USA;Division of Infectious Diseases, University of North Carolina, 27599, Chapel Hill, NC, USA;UNC Project-Malawi, Lilongwe, Malawi;UNC Project-Malawi, Lilongwe, Malawi;

关键词: Malaria;    Global Position System;    Rapid Diagnostic Test;    Malaria Prevalence;    Average Marginal Effect;   

DOI  :  10.1186/s12936-017-1767-2

 received in 2016-11-28, accepted in 2017-03-08,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsAn 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).ResultsFrom 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)].ConclusionsMalawi’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.

【 授权许可】

CC BY   
© The Author(s) 2017