Effect of large-scale social marketing of insecticide-treated nets on child survival in rural Tanzania
Effect of large-scale social marketing of insecticide-treated nets on child survival in rural Tanzania
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DOI：
10.1016/s0140-6736(00)04404-4
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发表时间：
2001-04-21
期刊：
影响因子：
168.9
通讯作者：
Lengeler, C
中科院分区：
文献类型：
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作者：
Schellenberg, JRMA;Abdulla, S;Lengeler, C
背景在非洲，驱虫蚊帐已被证明是疟疾控制的有效工具。然而，不能想当然地认为从有效性到有效性的过渡。我们评估了在坦桑尼亚南部两个常年疟疾传播率较高的农村地区大规模社会营销驱虫蚊帐的覆盖率和对儿童生存的影响。方法从1997年5月开始，在48万人口中分两年逐步推广社会营销驱虫蚊帐。在基线和1、2、3年后进行横断面覆盖调查。在一个拥有6万人口的地区建立了人口监测系统(DSS)，记录人口、出生和死亡情况。在DSS区域内，采用病例对照方法评估了驱虫蚊帐对儿童生存的影响。病例为1个月至4岁儿童死亡。从DSS数据库中为每个病例选择四个对照。对驱虫蚊帐的使用情况和潜在的混杂因素进行了问卷调查。病例对照研究的个人有效性评估与覆盖率相结合，以估计社区有效性。DSS地区发现的经杀虫剂处理的婴儿净覆盖率从基线的不到10%上升到3年后的50%以上。经杀虫剂处理的蚊帐与1个月至4岁儿童的存活率增加27%有关(95%可信区间3-45)。在获得该方案的时间较长的地区，这类儿童的覆盖率较高。到1999年，这两个地区实现了适度的平均覆盖率(5岁以下儿童的覆盖率为18%)，这表明当时驱虫蚊帐防止了20名儿童死亡中的1/20。
Background Insecticide-treated nets have proven efficacy as a malaria-control tool in Africa. However, the transition from efficacy to effectiveness cannot be taken for granted. We assessed coverage and the effect on child survival of a large-scale social marketing programme for insecticide-treated nets in two rural districts of southern Tanzania with high perennial malaria transmission.Methods Socially marketed insecticide-treated nets were introduced stepwise over a 2-year period from May, 1997, in a population of 480 000 people. Cross-sectional coverage surveys were done at baseline and after 1, 2, and 3 years. A demographic surveillance system (DSS) was set up in an area of 60 000 people to record population, births, and deaths. Within the DSS area, the effect of insecticide-treated nets on child survival was assessed by a case-control approach. Cases were deaths in children aged between 1 month and 4 years. Four controls for each case were chosen from the DSS database. Use of insecticide-treated nets and potential confounding factors were assessed by questionnaire. Individual effectiveness estimates from the case-control study were combined with coverage to estimate community effectiveness.Findings Insecticide-treated net coverage of infants in the DSS area rose from less than 10% at baseline to more than 50% 3 years later. Insecticide-treated nets were associated with a 27% increase in survival in children aged 1 month to 4 years (95% CI 3-45). Coverage in such children was higher in areas with longer access to the programme. The modest average coverage achieved by 1999 in the two districts (18% in children younger than 5 years) suggests that insecticide-treated nets prevented 1 in 20 child deaths at that time.Interpretation Social marketing of insecticide-treated nets has great potential for effective malaria control in rural African settings.