Abstract
BackgroundLong-lasting insecticidal nets (LLINs) are an important tool for controlling malaria. Much attention has been devoted to determine both the effect of LLINs on the reduction of Plasmodium infection rate and on clinically-confirmed malaria cases in sub-Saharan Africa. We carried out an epidemiological study to investigate whether LLINs impact on Plasmodium prevalence rate and the proportion of clinically-confirmed malaria cases, in five villages in the district of Toumodi, central Côte d'Ivoire.MethodsFrom April 2007 to November 2008, a community-based malaria control programme was implemented in the study villages, which involved large-scale distribution of LLINs, and training and sensitization activities within the community. We determined the effect of this programme on Plasmodium prevalence rate, clinically-confirmed malaria cases and proportion of high parasitaemia rates in children aged 6-59 months through a series of cross-sectional surveys starting in April 2007 and repeated once every 6 months.ResultsWe observed a significant decrease in the mean P. falciparum prevalence rate from April 2007 to April 2008 (p = 0.029). An opposite trend was observed from November 2007 to November 2008 when P. falciparum prevalence rate increased significantly (p = 0.003). Highly significant decreases in the proportions of clinical malaria cases were observed between April 2007 and April 2008 (p < 0.001), and between November 2007 and November 2008 (p = 0.001).ConclusionsLarge-scale distribution of LLINs, accompanied by training and sensitization activities, significantly reduced Plasmodium prevalence rates among young children in the first year of the project, whereas overall clinical malaria rates dropped over the entire 18-month project period. A decrease in community motivation to sleep under bed nets, perhaps along with changing patterns of malaria transmission, might explain the observed increase in the Plasmodium prevalence rate between November 2007 and November 2008.
Highlights
Long-lasting insecticidal nets (LLINs) are an important tool for controlling malaria
In Côte d’Ivoire, insecticide-treated nets (ITNs) coverage is low [4], with most of the nets in use being ‘untreated’
The variation observed in the number of children examined is explained by the fact that during each survey, we examined children who were available and agreed to participate to the study
Summary
Long-lasting insecticidal nets (LLINs) are an important tool for controlling malaria. Much attention has been devoted to determine both the effect of LLINs on the reduction of Plasmodium infection rate and on clinically-confirmed malaria cases in sub-Saharan Africa. To remain effective, nets need to be re-treated after several months, but re-treatment requires additional skills, and technical knowledge together with affordable products and community participation [5]. Inadequacy of these and other factors may hamper the expansion of largescale programmes involving insecticidal nets, and re-impregnation rates remain low and the nets become ineffective [6]. Several types of long-lasting insecticidal net (LLIN) treatments have been developed and evaluated in a wide range of situations [7]
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