Rickard Diana G, Dudovitz Rebecca N, Wong Mitchell D, Jen Howard C, Osborn Rebecca D, Fernandez Hilda E, Donkor Clement I
Department of Health Services, University of California Los Angeles, USA.
Prog Community Health Partnersh. 2011 Summer;5(2):123-31. doi: 10.1353/cpr.2011.0018.
Malaria is the leading cause of morbidity and mortality in children younger than 5 years old and pregnant women in sub-Saharan Africa. Insecticide-treated nets (ITNs) reduce clinical malaria by more than 50% and all cause mortality in young children by 15% to 30%. However, use of these nets is poor across sub-Saharan Africa, limiting the potential impact of this effective tool in the fight against malaria.
We sought to improve the use of ITNs using a community-created and -implemented approach, and measure the change in ITN use over the year after implementation.
Using a community-based participatory research approach, we created and implemented an intervention to improve ITN use in a rural village. Our intervention involved providing hands-on instructions and assistance in hanging of nets, in-home small group education, and monthly follow-up by trained community members. ITN use was measured for all individuals in a subset of the community (61 households, 759 individuals) at baseline and at 6 months and 1 year after distribution.
Rates of individual usage increased significantly from 29% at baseline to 88.7% (p < .001) at 6 months and to 96.6% (p < .001) at 12 months. For children under age 5, usage rates increased from 46% at baseline to 95.7% (p < .001) at 6 months and 95.4% (p < .001) at 12 months.
Our study demonstrates that rapidly achieving and sustaining almost universal ITN usage rates is possible using a community-based approach. Closing the gap between ITN ownership and use will help communities to realize the full potential of ITNs in the prevention of malaria.
疟疾是撒哈拉以南非洲地区5岁以下儿童和孕妇发病及死亡的主要原因。经杀虫剂处理的蚊帐（ITN）可使临床疟疾发病率降低50%以上，并使幼儿的全因死亡率降低15%至30%。然而，撒哈拉以南非洲地区对这些蚊帐的使用率很低，限制了这一有效工具在抗击疟疾方面的潜在影响。
我们试图采用社区创建和实施的方法来提高ITN的使用率，并衡量实施后一年内ITN使用率的变化。
采用基于社区的参与性研究方法，我们在一个乡村创建并实施了一项干预措施以提高ITN的使用率。我们的干预措施包括提供悬挂蚊帐的实际操作指导和协助、家庭小组教育以及由经过培训的社区成员进行每月随访。在基线时以及分发后6个月和1年，对社区一个子集（61户家庭，759人）中的所有个体测量ITN的使用率。
个体使用率从基线时的29%显著增加到6个月时的88.7%（p < .001）和12个月时的96.6%（p < .001）。对于5岁以下儿童，使用率从基线时的46%增加到6个月时的95.7%（p < .001）和12个月时的95.4%（p < .001）。
我们的研究表明，采用基于社区的方法能够迅速实现并维持几乎普遍的ITN使用率。缩小ITN拥有率和使用率之间的差距将有助于社区充分发挥ITN在预防疟疾方面的潜力。
