Abstract
Context: The resistance to pyrethroids in malaria vectors continues to grow in Africa and could therefore compromise or reduce substantially the effectiveness of LLINs in preventing malaria. It is therefore of paramount importance to evaluate the protective efficacy of LLINs in children sleeping in areas of vector resistance to insecticides in order to draw lessons for future interventions. This study assesses the effect of the use of LLINs on malaria morbidity in clusters of low and high resistance of vectors to pyrethroids. Methods: This is a cross-sectional case-control study with one control for one case that was conducted in the communes of Kétou, Ifangni, Kétou, and Pobè in the Plateau department of southern Benin. The use of LLINs and malaria morbidity was measured and compared in children from clusters of low and high vector resistance to insecticides. In each commune, 30 cases and 30 controls were recruited for a total of 240 children under 5 years of age from villages with low and high insecticide resistance. Results: According to the localities of origin of the children, of all parents of children surveyed, 169 (70.4%) asserted the children slept under an LLIN the day before they arrived at the health center. This rate represents 70.8% (85 children) among the cases and 70.0% (84 children) among the controls without significant difference (p = 0.8). The use of LLINs the day before the survey, the frequency of their use during the two weeks preceding the day of the survey, their availability at the household level, the use of other tools for protection against mosquito bites are the same in the two groups of children (cases and controls) (p > 0.05) as well in low and high resistance villages. On the other hand, the parasite prevalence, the splenomegaly and the geometric means of the parasite densities, are significantly higher in the cases than in the controls (p < 0.05). Conclusion: The evaluation of epidemiological indicators in children under five years old at the level of health centers did not enable demonstrating the impact of resistance on the operational effectiveness of the LLINs. The information collected within the four health facilities only reflects the situation that should normally be seen in the population under the real conditions of use of LLINs in high and low resistance areas.
Highlights
It is of paramount importance to evaluate the protective efficacy of LLINs in children sleeping in areas of vector resistance to insecticides in order to draw lessons for future interventions
The information collected within the four health facilities only reflects the situation that should normally be seen in the population under the real conditions of use of LLINs in high and low resistance areas
The expected protective efficacy of the use of LLINs against malaria morbidity in children under 5 years old was assessed on the basis of information received from mothers or caregivers who came to health care facilities to request for the services of health workers
Summary
Malaria control is a priority for health authorities in endemic countries. As part of the prevention of this disease, vector control is a very important and closely monitored axis [1]. LLINs are the main tool of the fight and a lot of efforts are made to increase their accessibility to populations, in particular children under five and pregnant women. The Demographic Health Survey conducted in Benin in 2006 showed that only 33% of children under five and 32% of pregnant women slept under an LLIN [2]. These rates are far below the 80% coverage threshold recommended by the World Health Organization [3]. Results from the EDS-V [6] showed a better possession and use of LLINs in children under five and pregnant women. Usage rates reached 79.7% and 87.4% among children under five and pregnant women respectively, with an average number of 2.3 LLINs per household
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