Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
PLoS Med. 2011 Sep;8(9):e1001091. doi: 10.1371/journal.pmed.1001091. Epub 2011 Sep 6.
Several sub-Saharan African countries have rapidly scaled up the number of households that own insecticide-treated mosquito nets (ITNs). Although the efficacy of ITNs in trials has been shown, evidence on their impact under routine conditions is limited to a few countries and the extent to which the scale-up of ITNs has improved population health remains uncertain.
We used matched logistic regression to assess the individual-level association between household ITN ownership or use in children under 5 years of age and the prevalence of parasitemia among children using six malaria indicator surveys (MIS) and one demographic and health survey. We used Cox proportional hazards models to assess the relationship between ITN household ownership and child mortality using 29 demographic and health surveys. The pooled relative reduction in parasitemia prevalence from random effects meta-analysis associated with household ownership of at least one ITN was 20% (95% confidence interval [CI] 3%-35%; I² = 73.5%, p<0.01 for I² value). Sleeping under an ITN was associated with a pooled relative reduction in parasitemia prevalence in children of 24% (95% CI 1%-42%; I² = 79.5%, p<0.001 for I² value). Ownership of at least one ITN was associated with a pooled relative reduction in mortality between 1 month and 5 years of age of 23% (95% CI 13-31%; I² = 25.6%, p>0.05 for I² value).
Our findings across a number of sub-Saharan African countries were highly consistent with results from previous clinical trials. These findings suggest that the recent scale-up in ITN coverage has likely been accompanied by significant reductions in child mortality and that additional health gains could be achieved with further increases in ITN coverage in populations at risk of malaria. Please see later in the article for the Editors' Summary.
撒哈拉以南非洲的一些国家迅速扩大了拥有驱虫蚊帐（ITN）的家庭数量。尽管在试验中已经证明了 ITN 的功效，但关于其在常规条件下的影响的证据仅限于少数几个国家，而且 ITN 的推广在多大程度上改善了人口健康状况仍不确定。
我们使用匹配的逻辑回归来评估儿童在 5 岁以下拥有或使用 ITN 与儿童中寄生虫患病率之间的个体水平关联。我们使用 Cox 比例风险模型，利用 29 项人口与健康调查评估 ITN 家庭所有权与儿童死亡率之间的关系。来自随机效应荟萃分析的与家庭拥有至少一个 ITN 相关的寄生虫患病率相对减少率为 20%（95%置信区间 [CI] 3%-35%；I²=73.5%，I²值 p<0.01）。使用 ITN 睡觉与寄生虫患病率的相对减少率相关，降低了 24%（95% CI 1%-42%；I²=79.5%，I²值 p<0.001）。拥有至少一个 ITN 与 1 个月至 5 岁儿童的死亡率相对减少率相关，为 23%（95% CI 13-31%；I²=25.6%，I²值 p>0.05）。
我们在多个撒哈拉以南非洲国家的发现与之前的临床试验结果高度一致。这些发现表明，最近 ITN 覆盖范围的扩大可能伴随着儿童死亡率的显著降低，如果进一步增加疟疾高危人群的 ITN 覆盖率，可能会获得更多的健康收益。请在文章稍后查看编辑摘要。
