Abstract
Bed nets averted 68% of malaria cases in Africa between 2000 and 2015. However, concerns over insecticide resistance, bed net durability and the effectiveness of long-lasting insecticidal nets (LLIN) are growing. To assess the effectiveness of LLINs of different ages and insecticides against malaria, we conducted a population-based, cross-sectional study using data from 162,963 children younger than 5 years of age participating in 33 Demographic and Health and Malaria Indicator Surveys conducted in 21 countries between 2009 and 2016. We used Bayesian logistic regression to estimate associations between LLIN age, insecticide type, and malaria. Children sleeping under LLINs the previous night experienced 21% lower odds of malaria infection than children who did not (odds ratio [OR] 0.79; 95% Uncertainty Interval [UI] 0.76–0.82). Nets less than one year of age exhibited the strongest protective effect (OR 0.75; 95% UI 0.72–0.79), and protection weakened as net age increased. LLINs containing different insecticides exhibited similar protection (ORdeltamethrin 0.78 [0.75–0.82]; ORpermethrin 0.79 [0.75–0.83]; ORalphacypermethrin 0.85 [0.76–0.94]). Freely-available, population-based surveys can enhance and guide current entomological monitoring amid concerns of insecticide resistance and bed net durability, and be used with locally-collected data to support decisions on LLIN redistribution campaign timing which insecticide to use.
Highlights
Investment in malaria control has greatly reduced transmission
A total 169,013 children younger than 5 years of age from 33 Demographic and Health Surveys (DHS) and Malaria Indicator Surveys (MIS) surveys conducted in 21 countries from 2009 to 2016 across sub-Saharan Africa were initially screened for inclusion
43,397 (27%) children tested positive for malaria by rapid diagnostic test (RDT), while 87,421 children (54%) were reported to have slept under an long-lasting insecticidal nets (LLIN) the previous night
Summary
Investment in malaria control has greatly reduced transmission. An estimated 663 million cases have been averted worldwide between 2000 and 2015, with 68% of them attributed to insecticide-treated nets[1]. A recent study using population-based, cross-sectional surveys from seven countries across sub-Saharan Africa found that children sleeping under an insecticide-treated bed net the previous night experienced 24% lower odds of malaria[23]. The aim of this study is to use DHS and MIS surveys to assess the effect of LLINs on the odds of malaria infection in children less than 5 years of age across 21 countries in sub-Saharan Africa. It investigates whether protection varies with LLINs of different ages and impregnated with different insecticides, and explores whether these effects vary by country
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