Effect of expanded insecticide-treated bednet coverage on child survival in rural Kenya: a longitudinal study
Effect of expanded insecticide-treated bednet coverage on child survival in rural Kenya: a longitudinal study
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DOI：
10.1016/s0140-6736(07)61477-9
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发表时间：
2007-09-22
期刊：
影响因子：
168.9
通讯作者：
Snow, Robert W.
中科院分区：
文献类型：
--
作者：
Fegan, Greg W.;Noor, Abdisalan M.;Snow, Robert W.
背景：经杀虫剂处理的蚊帐（ITNs）有助于儿童生存的潜力在随机对照试验中得到了很好的证明。在肯尼亚，驱虫蚊帐的覆盖率从2004年的7%迅速增加到2006年的67%。我们的目的是评估在何种程度上，这种投资已导致改善儿童survival.Methods一个动态队列的约3500名儿童年龄1-59个月，每年的间隔在72个农村集群位于肯尼亚的四个地区列举了三次。使用ITN对死亡率的影响进行了评估，泊松回归考虑到潜在的影响修改和混杂的协变量。研究的第一年和第二年的总体死亡率大致相同（第一年为14.5/1000人年，第二年为15.4/1000人年）。在调整年龄、时间段和一些其他可能的混杂变量后，ITN的使用与死亡率降低44%相关（死亡率比0.56，95%CI 0.33-0.96; p=0.04）。这一保护水平相当于每1000个驱虫蚊帐分发可避免约7例死亡。解释社会营销的结合方法，然后大规模免费分发驱虫蚊帐转化为儿童生存效果，与以前的随机对照试验中看到的效果相当。
Background The potential of insecticide-treated bednets (ITNs) to contribute to child survival has been well documented in randomised controlled trials. ITN coverage has increased rapidly in Kenya from 7% in 2004 to 67% in 2006. We aimed to assess the extent to which this investment has led to improvements in child survival.Methods A dynamic cohort of about 3500 children aged 1-59 months were enumerated three times at yearly intervals in 72 rural clusters located in four districts of Kenya. The effect of ITN use on mortality was assessed with Poisson regression to take account of potential effect-modifying and confounding covariates.Findings 100 children died over 2 years. Overall mortality rates were much the same in the first and second years of the study (14.5 per 1000 person-years in the first year and 15.4 per 1000 person-years in the second). After adjustment for age, time period, and a number of other possible confounding variables, ITN use was associated with a 44% reduction in mortality (mortality rate ratio 0.56, 95% CI 0.33-0.96; p=0.04). This level of protection corresponds to about seven deaths averted for every 1000 ITNs distributed.Interpretation A combined approach of social marketing followed by mass free distribution of ITNs translated into child survival effects that are comparable with those seen in previous randomised controlled trials.