Abstract
BackgroundInsecticide treated nets (ITN) have been proven to be an effective tool in reducing the burden of malaria. Few randomized clinical trials examined the spatial effect of ITNs on child mortality at a high coverage level, hence it is essential to better understand these effects in real-life situation with varying levels of coverage. We analyzed for the first time data from a large follow-up study in an area of high perennial malaria transmission in southern Tanzania to describe the spatial effects of bednets on all-cause child mortality.MethodsThe study was carried out between October 2001 and September 2003 in 25 villages in Kilombero Valley, southern Tanzania. Bayesian geostatistical models were fitted to assess the effect of different bednet density measures on child mortality adjusting for possible confounders.ResultsIn the multivariate model addressing potential confounding, the only measure significantly associated with child mortality was the bed net density at household level; we failed to observe additional community effect benefit from bed net coverage in the community.ConclusionIn this multiyear, 25 village assessment, despite substantial known inadequate insecticide-treatment for bed nets, the density of household bed net ownership was significantly associated with all cause child mortality reduction. The absence of community effect of bednets in our study area might be explained by (1) the small proportion of nets which are treated with insecticide, and (2) the relative homogeneity of coverage with nets in the area. To reduce malaria transmission for both users and non-users it is important to increase the ITNs and long-lasting nets coverage to at least the present untreated nets coverage.
Highlights
Insecticide treated nets (ITN) have been proven to be an effective tool in reducing the burden of malaria
In western Kenya households without ITNs but within 300 m of ITN villages received nearly full protection [9]. These results conflict with those found from studies in The Gambia which concluded that protection against malaria seen in children using ITN is due to personal rather than community effect [10,11,12]
The insecticide treatment status of the nets was difficult to ascertain, the results reported refer to bednets only, whether treated or not
Summary
Insecticide treated nets (ITN) have been proven to be an effective tool in reducing the burden of malaria. Few randomized clinical trials examined the spatial effect of ITNs on child mortality at a high coverage level, it is essential to better understand these effects in real-life situation with varying levels of coverage. We analyzed for the first time data from a large followup study in an area of high perennial malaria transmission in southern Tanzania to describe the spatial effects of bednets on all-cause child mortality. In western Kenya households without ITNs but within 300 m of ITN villages received nearly full protection [9] These results conflict with those found from studies in The Gambia which concluded that protection against malaria seen in children using ITN is due to personal rather than community effect [10,11,12]. Models for geostatistical data introduce the spatial correlation in the covariance matrix of the household-specific random effects and model fit is based on Markov chain Monte Carlo methods (MCMC).
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