Effect of community-wide use of insecticide-treated nets for 3-4 years on malarial morbidity in Tanzania
Effect of community-wide use of insecticide-treated nets for 3-4 years on malarial morbidity in Tanzania
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DOI：
10.1046/j.1365-3156.2002.00966.x
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发表时间：
2002-12-01
影响因子：
3.3
通讯作者：
Curtis, CF
中科院分区：
文献类型：
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作者：
Maxwell, CA;Msuya, E;Curtis, CF
目的调查(1)个人保护蚊帐使用者的益处与广泛使用蚊帐在村庄内大规模杀灭蚊子的益处；(2)驱虫蚊帐防治疟疾发病率的效益在几年内的可持续性；(3)不同年龄段儿童的效益分配情况；(4)由于免疫力减弱，年龄较大的年龄组是否为他们在幼年时享有的效益支付费用。方法(1)对早期数据进行列表，比较个人和社区范围内对蚊媒的影响；(2)对坦桑尼亚8个村庄儿童疟疾原虫血症、疟疾发热、贫血和脾肿大进行两次横断面调查，在社区范围内使用每年重新使用高效氯氰菊酯的蚊帐3-4年；(3)不同年龄组儿童与这些村庄和4-6个未使用蚊帐的村庄的比较。在网状村庄发现，6个月至2岁儿童的疟疾发病率显著降低(55%-75%)，某些结果是，在那些本身拥有完整处理过的蚊帐的个人中，效果更好。对于年龄较大的儿童，好处不太明显或没有，但没有迹象表明，儿童早期的好处是由儿童时期使用蚊帐的村庄更糟糕的结果来支付的。结论广泛使用处理过的蚊帐对社区的总体好处是可持续的，不会因为免疫力的减弱而在3-4年内逆转。重要的是要确保足够高的覆盖率，以实现处理后的净网方法的全部潜力。通过显示对社区中病媒种群的影响，这些结果为有组织地免费提供蚊帐治疗而不是依赖于营销提供了强有力的论据。
Objectives To investigate (1) benefits due to personal protection of individual net users vs. mass killing of mosquitoes within villages as a result of widespread net usage; (2) sustainability over several years of benefits against malarial morbidity of insecticide-treated nets; ( 3) distribution of the benefits in different age groups of children and (4) whether, as a result of fading immunity, older age groups 'paid for' the benefits which they had enjoyed when younger.Methods (1) Tabulation of earlier data to compare personal and community-wide effects against mosquito vectors; (2) two cross-sectional surveys for malaria parasitaemia, malarial fever, anaemia and splenomegaly in children in eight Tanzanian villages, in which there had been community-wide use of bednets which had been annually re-treated with alphacypermethrin for 3-4 years; ( 3) comparison between children of different age groups and with intact, torn or no nets in these villages and in 4-6 villages without nets.Results A 90-95% reduction in infective bites outside nets in netted villages and an additional 54-82% reduction of bites among individual net users. Highly significant reductions ( by 55-75%) in malarial morbidity for children aged 6 months to 2 years were found in netted villages with, for some outcomes, better results among individuals who themselves had intact treated nets. For older children, benefits were less clear or absent, but there was no sign that the benefits early in life were 'paid for' by worse outcomes in the netted villages later in childhood.Conclusions The overall benefits to the community of widespread use of treated nets are sustainable and are not reversed in 3-4 years as a result of fading immunity. It is important to ensure high enough coverage to realize the full potential of the treated net method. By showing an impact on the vector population in the community these results provide a strong argument for organized free provision of net treatment, rather than relying on marketing.