Sustainability of reductions in malaria transmission and infant mortality in Western Kenya with use of insecticide-treated bednets - 4 to 6 years of follow-up
Sustainability of reductions in malaria transmission and infant mortality in Western Kenya with use of insecticide-treated bednets - 4 to 6 years of follow-up
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DOI：
10.1001/jama.291.21.2571
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发表时间：
2004-06-02
影响因子：
120.7
通讯作者：
Slutsker, L
中科院分区：
文献类型：
--
作者：
Lindblade, KA;Eisele, TP;Slutsker, L
在短期试验中，经过杀虫剂处理的蚊帐可减少疟疾传播和儿童发病率和死亡率，但这种影响可能不可持续。以前，研究人员曾提出，使用蚊帐可能会通过延迟获得对疟疾的免疫力而矛盾地增加年龄较大儿童的死亡率。目的确定使用杀虫剂处理的蚊帐的坚持和公共健康益处是否可以随着时间的推移而持续下去，以及在婴儿时期使用蚊帐是否会增加常年疟疾高传播区较大儿童的全因死亡率。在肯尼亚西部设计和建立一项社区随机对照试验(第一阶段：1997年1月至2000年2月)，然后继续监测依从性、昆虫学参数、发病率指标和全原因死亡率(第二阶段：1999年4月至2002年2月)，研究对象在阿森博和吉姆村的130000名居民中，在第一阶段(111个村庄)和第二阶段(110个村庄)开始时随机接受驱虫蚊帐。主要结果衡量5岁以下儿童使用驱虫蚊帐的比例、平均每户按蚊数量和全因死亡率。
Context Insecticide-treated bednets reduce malaria transmission and child morbidity and mortality in short-term trials, but this impact may not be sustainable. Previous, investigators have suggested that bednet use might paradoxically increase mortality in older children through delayed acquisition of immunity to malaria.Objectives To determine whether adherence to and public health benefits of insecticide-treated bednets can be sustained over time and whether bednet use during infancy increases all-cause mortality rates in older children in an area of intense perennial malaria transmission.Design and Setting A community randomized controlled trial in western Kenya (phase 1: January 1997 to February 2000) followed by continued surveillance of adherence, entomologic parameters, morbidity indicators, and all-cause mortality (phase 2: April 1999 to February 2002), and extended demographic monitoring (January to December 2002).Participants A total of 130000 residents of 221 villages in Asembo and Gem were randomized to receive insecticide-treated bednets at the start of phase 1 (111 villages) or phase 2 (110 villages).Main Outcome Measures Proportion of children younger than 5 years using insecticide-treated bednets, mean number of Anopheles mosquitoes per house, and all-cause mortality rates.Results Adherence to bednet use in children younger than 5 years increased from 65.9% in phase 1 to 82.5% in phase 2 (P