Abstract
We examined the relationship between insecticide-treated mosquito nets (ITNs), malaria parasite infection, and severe anemia prevalence in children in Luangwa District, Zambia, an area with near-universal ITN coverage, at the end of the 2008 and 2010 malaria transmission seasons. Malaria parasite infection prevalence among children < 5 years old was 9.7% (95% confidence interval [CI] = 8.0–11.4%) over both survey years. Prevalence of severe anemia among children 6–59 months old was 6.9% (95% CI = 5.4–8.5%) over both survey years. Within this context of near-universal ITN coverage, we were unable to detect a significant association between malaria parasite or severe anemia prevalence and ITNs (possession and use). In addition to maintaining universal ITN coverage, it will be essential for the malaria control program to achieve high ITN use and laboratory diagnosis and treatment of all fevers among all age groups to further reduce the malaria burden in this area.
Highlights
Community randomized controlled trials have shown insecticide-treated mosquito nets (ITNs) to be an effective strategy for preventing malaria morbidity and all causes of mortality among children in Plasmodium falciparum endemic settings.[1]
This paper examines the relationship between ITN possession and use and the outcomes of malaria parasite infection and severe anemia in children in Luangwa District, Zambia, in 2008 and 2010, an area with near-universal coverage of ITNs
Additional regressions were performed using ITN to occupant ratio as a second test variable and proxy for ITN ownership and whether anyone in the house slept under an ITN as a test variable and proxy for ITN use; results of these additional regressions were similar to the results that we present here and showed that ITN possession and use were not significantly associated with malaria parasite infection prevalence or severe anemia in this context
Summary
Community randomized controlled trials have shown insecticide-treated mosquito nets (ITNs) to be an effective strategy for preventing malaria morbidity and all causes of mortality among children in Plasmodium falciparum endemic settings.[1]. There has recently been a call for universal coverage of ITNs across malaria endemic countries in Africa, defined in the Global Malaria Action Plan as 100% coverage of ITNs among at-risk populations.[3] There are household surveys in many malaria endemic countries of Africa, which include biomarkers for measuring the prevalence of malaria parasite infections and severe anemia in children, that can be used for monitoring and evaluating malaria control programs, especially within countries scaling-up ITN coverage. To date, there are relatively little data showing the relationship between ITNs (household possession and use) and malaria parasite infection prevalence in children under program conditions that have achieved near-universal coverage. Because of the community effect observed during trials, where ITNs confer protective benefits to unprotected children at very high intervention coverage levels,[4,5] reductions in malaria parasite prevalence associated with ITNs may be lower than expected as near-universal coverage is achieved under program conditions
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