Pinchoff Jessie, Hamapumbu Harry, Kobayashi Tamaki, Simubali Limonty, Stevenson Jennifer C, Norris Douglas E, Colantuoni Elizabeth, Thuma Philip E, Moss William J
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Macha Research Trust, Choma District, Zambia; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Am J Trop Med Hyg. 2015 Nov;93(5):954-60. doi: 10.4269/ajtmh.15-0093. Epub 2015 Aug 31.
Understanding factors influencing sustained use of long-lasting insecticide-treated nets (LLIN) in areas of declining malaria transmission is critical to sustaining control and may facilitate elimination. From 2008 to 2013, 655 households in Choma District, Zambia, were randomly selected and residents were administered a questionnaire and malaria rapid diagnostic test. Mosquitoes were collected concurrently by light trap. In a multilevel model, children and adolescents of 5-17 years of age were 55% less likely to sleep under LLIN than adults (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.35, 0.58). LLIN use was 80% higher during the rainy season (OR = 1.8; CI = 1.5, 2.2) and residents of households with three or more nets were over twice as likely to use a LLIN (OR = 2.1; CI = 1.4, 3.1). For every increase in 0.5 km from the nearest health center, the odds of LLIN use decreased 9% (OR = 0.9; CI = 0.88, 0.98). In a second multilevel model, the odds of LLIN use were more than twice high if more than five mosquitoes (anopheline and culicine) were captured in the house compared with households with no mosquitoes captured (OR = 2.1; CI = 1.1, 3.9). LLIN use can be sustained in low-transmission settings with continued education and distributions, and may be partially driven by the presence of nuisance mosquitoes.
了解在疟疾传播率下降地区影响长效驱虫蚊帐（LLIN）持续使用的因素对于维持疟疾防控至关重要，且可能有助于实现消除疟疾的目标。2008年至2013年期间，在赞比亚乔马区随机抽取了655户家庭，对居民进行问卷调查并开展疟疾快速诊断检测。同时用诱蚊灯收集蚊子。在一个多层次模型中，5至17岁的儿童和青少年睡在长效驱虫蚊帐下的可能性比成年人低55%（优势比[OR]=0.45；95%置信区间[CI]=0.35，0.58）。在雨季，长效驱虫蚊帐的使用率高出80%（OR=1.8；CI=1.5，2.2），拥有三张或更多蚊帐的家庭居民使用长效驱虫蚊帐的可能性是其他家庭的两倍多（OR=2.1；CI=1.4，3.1）。距离最近的卫生中心每增加0.5公里，使用长效驱虫蚊帐的几率就降低9%（OR=0.9；CI=0.88，0.98）。在第二个多层次模型中，与未捕获蚊子的家庭相比，如果房屋内捕获的蚊子（按蚊和库蚊）超过五只，使用长效驱虫蚊帐的几率高出两倍多（OR=2.1；CI=1.1，3.9）。通过持续开展教育和分发工作，长效驱虫蚊帐的使用在低传播环境中可以持续下去，而且可能部分是由滋扰蚊虫的存在所驱动的。
