Long-term use of insecticide treated bed nets reduces malaria transmission and death rates in children

Abstract

SummaryQuestionWhat is the effect of long-term use of insecticide-treated bed nets on malaria transmission and death rates in children?Study DesignCommunity randomised controlled trial.Main ResultsAll-cause mortality rates in infants (aged 1 to 11 months) were lower in villages with higher bed net use, compared with control villages (HR: 0.78, 95% CI 0.67 to 0.90). Despite much reduced exposure to malaria (and therefore the risk of reduced immunity), there was no difference in death rates of children born in intervention and control households after 6 years of bed-net use (HR during phase 1: 1.01, 95% CI 0.86 to 1.19; HR after phase 1: 0.97, 95% CI 0.61 to 1.52). Overall, the number of Anopheles mosquitoes per house was lower in houses with bed nets (reduction during phase 1:72%; RR: 0.28, 95% CI 0.16 to 0.51; reduction after 3 to 4 years: 77%, RR: 0.23, 95% CI 0.15 to 0.35). When bed nets were available, young children (aged 0–5 years) increasingly used them over time (65.9% in phase 1 v 82.5% in phase 2; p<0.001).Authors’ conclusionsLong-term use of insecticide treated bed nets significantly reduces malaria transmission and malaria-related mortality. There was no increase in all-cause mortality in children who had used bed-nets from birth.