Howard S C, Omumbo J, Nevill C, Some E S, Donnelly C A, Snow R W
Wellcome Trust Centre for the Epidemiology of Infectious Disease, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3FY, UK.
Trans R Soc Trop Med Hyg. 2000 Jul-Aug;94(4):357-60. doi: 10.1016/s0035-9203(00)90103-2.
The use of insecticide-treated bednets (ITBNs) has been shown to be effective in reducing mortality and morbidity from malaria. However, there is mixed evidence as to whether or not community-wide use of ITBNs engenders a 'mass effect', such that those not sleeping under bednets are offered protection from widespread ITBN use in the area in which they live. We have analysed data collected in Kilifi, Kenya, from a cohort of children followed from birth to investigate how the degree of net usage in the locality of a child affects the risk of developing malaria. This effect was explored using a Cox proportional hazards model. For those not using ITBNs, we found that an increasing level of ITBN usage within the area surrounding each child was associated with a decreasing risk of developing malaria, thus providing evidence in support of a mass community effect. The size and significance of this effect were found to decrease as non-overlapping areas of increasing distance away from a child's home were considered. The effect was significant for areas at distances of up to 1.5 km away from each child.
使用经杀虫剂处理的蚊帐（ITBNs）已被证明在降低疟疾死亡率和发病率方面是有效的。然而，关于社区范围内使用ITBNs是否会产生“群体效应”，即未睡在蚊帐下的人是否能因所在地区广泛使用ITBNs而获得保护，证据并不一致。我们分析了在肯尼亚基利菲收集的数据，这些数据来自一组从出生就开始跟踪的儿童，以研究儿童所在地区的蚊帐使用程度如何影响患疟疾的风险。使用Cox比例风险模型探讨了这种效应。对于未使用ITBNs的儿童，我们发现每个儿童周围地区ITBN使用水平的提高与患疟疾风险的降低相关，从而为群体社区效应提供了支持证据。当考虑离儿童家距离越来越远的非重叠区域时，发现这种效应的大小和显著性会降低。对于距离每个儿童家最远1.5公里的区域，这种效应是显著的。
