Long-term effects of malaria prevention with insecticide-treated mosquito nets on morbidity and mortality in African children: randomised controlled trial

作者：Louis Valerie R; Bals Joelle; Tiendrebeogo Justin; Bountogo Mamadou; Ramroth Heribert; De Allegri Manuela; Traore Corneille; Beiersmann Claudia; Coulibaly Boubacar; Ye Maurice; Jahn Albrecht; Becher Heiko; Mueller Olaf

来源：Tropical Medicine and International Health, 2012, 17(6): 733-741.

DOI：10.1111/j.1365-3156.2012.02990.x

• Africa
• malaria control
• children
• insecticide-treated mosquito nets
• immunity
• mortality
• morbidity
• child health
• birth cohort
• Burkina Faso
• Afrique
• lutte contre le paludisme
• malaria
• enfants
• moustiquaires impregnees d'insecticide
• ITN
• immunite
• mortalite
• morbidite
• sante des enfants
• cohorte de naissance
• Burkina-Faso
• Africa
• control malaria
• ninos
• mosquiteras impregnadas con insecticida
• ITNs
• inmunidad
• mortalidad
• morbilidad
• salud infantil
• cohorte de nacimientos
• Burkina Faso

Objective The objective is to investigate the effect of malaria control with insecticide-treated mosquito nets (ITNs) regarding possible higher mortality in children protected during early infancy, due to interference with immunity development, and to assess long-term effects on malaria prevalence and morbidity. Methods Between 2000 and 2002, a birth cohort was enrolled in 41 villages of a malaria holoendemic area in north-western Burkina Faso. All neonates (n = 3387) were individually randomised to ITN protection from birth (group A) vs. ITN protection from age 6 months (group B). Primary outcome was all-cause mortality. In 2009, a survey took place in six sentinel villages, and in 2010, a census was conducted in all study villages. Results After a median follow-up time of 8.3 years, 443/3387 (13.1%) children had migrated out of the area and 484/2944 (16.4%) had died, mostly at home. Long-term compliance with ITN protection was good. There were no differences in mortality between study groups (248 deaths in group A, 236 deaths in group B; rate ratio 1.05, 95% CI: 0.8891.237, P = 0.574). The survey conducted briefly after the rainy season in 2009 showed that more than 80% of study children carried asexual malaria parasites and up to 20% had clinical malaria. Conclusion Insecticide-treated mosquito net protection in early infancy is not a risk factor for mortality. Individual ITN protection does not sufficiently reduce malaria prevalence in high-transmission areas. Achieving universal ITN coverage remains a major challenge for malaria prevention in Africa.

• 出版日期2012-6