What Is Threatening the Effectiveness of Insecticide-Treated Bednets? A Case-Control Study of Environmental, Behavioral, and Physical Factors Associated with Prevention Failure
What Is Threatening the Effectiveness of Insecticide-Treated Bednets? A Case-Control Study of Environmental, Behavioral, and Physical Factors Associated with Prevention Failure
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DOI：
10.1371/journal.pone.0132778
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发表时间：
2015-07-14
期刊：
影响因子：
3.7
通讯作者：
O'Meara, Wendy Prudhomme
中科院分区：
文献类型：
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作者：
Obala, Andrew A.;Mangeni, Judith Nekesa;O'Meara, Wendy Prudhomme
背景驱虫蚊帐是全球疟疾控制的基石，已被证明可将疟疾发病率降低50- 60%。然而，一些地区在成功控制疟疾后，疟疾又死灰复燃。我们描述了一个效力衰减框架，以了解为什么高疟疾负担仍然存在，即使在高ITN覆盖率在肯尼亚西部的一个社区。MethodsWe招募了442名儿童住院治疗疟疾和配对的年龄，时间，村庄和性别匹配的控制。我们完成了全面的家庭和邻里评估，包括昆虫监测。这些指标在效力衰减框架中分为五个领域：驱虫蚊帐所有权、遵守情况、身体完整性、病媒易感性和促进因素。变量选择后，病例对照数据采用条件Logistic回归模型进行分析，蚊子数据采用负二项回归进行分析。预测利润率从Logistic回归models. ResultsITN覆盖率和身体完整性的措施计算与住院疟疾在我们的研究中。然而，持续使用驱虫蚊帐（调整的比值比（AOR）= 0.23，95% CI：0.12-0.43），附近存在幼虫部位（AOR = 1.137，95%CI：1.02-1.27），以及特定类型的作物（AOR（谷物）= 0.446，95%CI：0.24-0.82）与拥有驱虫蚊帐的儿童中的疟疾显著相关。当另一个家庭成员有症状性疟疾感染时，因发热性疟疾住院的几率几乎增加了两倍（AOR-2.76，95%CI：1.83-4.18）。总的来说，完美的家庭依从性可以将疟疾住院的概率降低到30%以下（95%CI：0.12-0.46），并调整环境因素如消除幼虫场所和在附近种植谷物，可将疟疾住院概率降低到20%以下（95%CI：0.04-0.31）.结论ITNs的可获得性不是该社区疟疾预防的瓶颈。改变行为的干预措施，以改善遵守和蚊子繁殖栖息地的环境管理，可以大大提高驱虫蚊帐的功效。需要更好地了解农业与蚊子生存和喂养成功之间的关系。
BackgroundInsecticide-treated nets are the cornerstone of global malaria control and have been shown to reduce malaria morbidity by 50-60%. However, some areas are experiencing a resurgence in malaria following successful control. We describe an efficacy decay framework to understand why high malaria burden persists even under high ITN coverage in a community in western Kenya.MethodsWe enrolled 442 children hospitalized with malaria and paired them with age, time, village and gender-matched controls. We completed comprehensive household and neighborhood assessments including entomological surveillance. The indicators are grouped into five domains in an efficacy decay framework: ITN ownership, compliance, physical integrity, vector susceptibility and facilitating factors. After variable selection, case-control data were analyzed using conditional logistic regression models and mosquito data were analyzed using negative binomial regression. Predictive margins were calculated from logistic regression models.ResultsMeasures of ITN coverage and physical integrity were not correlated with hospitalized malaria in our study. However, consistent ITN use (Adjusted Odds Ratio (AOR) = 0.23, 95% CI: 0.12-0.43), presence of nearby larval sites (AOR = 1.137, 95% CI: 1.02-1.27), and specific types of crops (AOR (grains) = 0.446, 95% CI: 0.24-0.82) were significantly correlated with malaria amongst children who owned an ITN. The odds of hospitalization for febrile malaria nearly tripled when one other household member had symptomatic malaria infection (AOR-2.76, 95% CI: 1.83-4.18). Overall, perfect household adherence could reduce the probability of hospitalization for malaria to less than 30% ( 95% CI: 0.12-0.46) and adjusting environmental factors such as elimination of larval sites and growing grains nearby could reduce the probability of hospitalization for malaria to less than 20% ( 95% CI: 0.04-0.31).ConclusionAvailability of ITNs is not the bottleneck for malaria prevention in this community. Behavior change interventions to improve compliance and environmental management of mosquito breeding habitats may greatly enhance ITN efficacy. A better understanding of the relationship between agriculture and mosquito survival and feeding success is needed.