Details:

Alternative Title:
Malar J
Personal Author:
Shah, Monica P. ; Steinhardt, Laura C. ; Mwandama, Dyson ; Mzilahowa, Themba ; Gimnig, John E. ; ... More +
Shah, Monica P. ; Steinhardt, Laura C. ; Mwandama, Dyson ; Mzilahowa, Themba ; Gimnig, John E. ; Bauleni, Andy ; Wong, Jacklyn ; Wiegand, Ryan ; Mathanga, Don P. ; Lindblade, Kim A. Less -
Description:
Background

A previous cohort study in Malawi showed that users of new insecticide-treated bed nets (ITNs) were significantly protected against malaria compared to non-users, despite moderate levels of pyrethroid resistance among the primary mosquito vectors. The present study investigated whether ITNs that were 1–2 years old continued to protect users in the same area with moderate pyrethroid resistance.

Methods

One year following a baseline cross-sectional malaria parasitaemia prevalence survey and universal distribution of deltamethrin ITNs (May 2012), a fixed cohort of 1223 children aged 6–59 months was enrolled (April 2013). Children were tested for parasitaemia at monthly scheduled visits and at unscheduled sick visits from May to December 2013 using rapid diagnostic tests. ITN use the prior night and the condition of ITNs (based on presence of holes) was assessed by caregiver self-report. The incidence rate ratio (RR) comparing malaria infection among users and non-users of ITNs was modelled using generalized estimating equations adjusting for potential confounders and accounting for repeated measures on each child. The protective efficacy (PE) of ITN use was calculated as 1 − RR.

Results

In this cohort, self-reported ITN use remained consistently high (> 95%) over the study period. Although users of ITNs were slightly more protected compared to non-users of ITNs, the difference in incidence of infection was not statistically significant (RR 0.83, 95% confidence interval [CI] 0.54–1.27). Among ITN users, malaria incidence was significantly lower in users of ITNs with no holes (of any size) compared to users of ITNs with ≥ 1 hole (RR 0.82, 95% CI 0.69–0.98).

Conclusions

There was no significant PE of using 1–2 year-old ITNs on the incidence of malaria in children in an area of moderate pyrethroid resistance, but among ITN users, the authors found increased protection by ITNs with no holes compared to ITNs with holes. Given the moderate levels of pyrethroid resistance in the primary malaria vector and recent evidence of added benefits of ITNs with synergists or non-pyrethroid insecticides, next-generation ITNs may be a useful strategy to address pyrethroid resistance and should be further explored in Malawi.


Subjects:
[+]
Holes Insecticide-treated Bed Nets Insecticide Resistance Malaria Prevention Research Vector Control
Source:
Malar J. 19
Pubmed ID:
31941502
Pubmed Central ID:
PMC6964029
Document Type:
Journal Article
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:e32e8955ef9c0546f712df995c548133a09343ad4f848161e4f143e32626f521
Download URL:
https://stacks.cdc.gov/view/cdc/87567/cdc_87567_DS1.pdf
File Type:

Supporting Files

• 	12936_2020_3106_Fig1_HTML.gif	gif
  	12936_2020_3106_Fig1_HTML.jpg	jpeg
  	12936_2020_3106_Fig2_HTML.gif	gif
  	12936_2020_3106_Fig2_HTML.jpg	jpeg
  	12936_2020_Article_3106.nxml	xml

More +