Florey Lia S, Bennett Adam, Hershey Christine L, Bhattarai Achuyt, Nielsen Carrie F, Ali Doreen, Luhanga Misheck, Taylor Cameron, Eisele Thomas P, Yé Yazoume
ICF, The DHS Program, Rockville, Maryland.
Malaria Elimination Initiative, University of California, San Francisco, California.
Am J Trop Med Hyg. 2017 Sep;97(3_Suppl):65-75. doi: 10.4269/ajtmh.15-0929.
Insecticide-treated nets (ITNs) have been shown to be highly effective at reducing malaria morbidity and mortality in children. However, there are limited studies that assess the association between increasing ITN coverage and child mortality over time, at the national level, and under programmatic conditions. Two analytic approaches were used to examine this association: a retrospective cohort analysis of individual children and a district-level ecologic analysis. To evaluate the association between household ITN ownership and all-cause child mortality (ACCM) at the individual level, data from the 2010 Demographic and Health Survey (DHS) were modeled in a Cox proportional hazards framework while controlling for numerous environmental, household, and individual confounders through the use of exact matching. To evaluate population-level association between ITN ownership and ACCM between 2006 and 2010, program ITN distribution data and mortality data from the 2006 Multiple Indicator Cluster Survey and the 2010 DHS were aggregated at the district level and modeled using negative binomial regression. In the Cox model controlling for household, child and maternal health factors, children between 1 and 59 months in households owning an ITN had significantly lower mortality compared with those without an ITN (hazard ratio = 0.75, 95% confidence interval [CI] = 0.62-90). In the district-level model, higher ITN ownership was significantly associated with lower ACCM (incidence rate ratio = 0.77; 95% CI = 0.60-0.98). These findings suggest that increasing ITN ownership may have contributed to the decline in ACCM during 2006-2010 in Malawi and represent a novel use of district-level data from nationally representative surveys.
经杀虫剂处理的蚊帐（ITN）已被证明在降低儿童疟疾发病率和死亡率方面非常有效。然而，在国家层面以及在项目实施条件下，评估ITN覆盖率随时间增加与儿童死亡率之间关联的研究有限。本研究采用了两种分析方法来检验这种关联：对个体儿童进行回顾性队列分析以及地区层面的生态分析。为了在个体层面评估家庭ITN拥有情况与全因儿童死亡率（ACCM）之间的关联，2010年人口与健康调查（DHS）的数据在Cox比例风险框架中进行建模，同时通过精确匹配控制众多环境、家庭和个体混杂因素。为了评估2006年至2010年间ITN拥有情况与ACCM之间的人群层面关联，2006年多指标类集调查和2010年DHS的项目ITN分发数据和死亡率数据在地区层面进行汇总，并使用负二项回归进行建模。在控制家庭、儿童和母亲健康因素的Cox模型中，拥有ITN的家庭中1至59个月大的儿童死亡率显著低于没有ITN的家庭（风险比 = 0.75，95%置信区间[CI] = 0.62 - 0.90）。在地区层面模型中，较高的ITN拥有率与较低的ACCM显著相关（发病率比 = 0.77；95% CI = 0.60 - 0.98）。这些发现表明，ITN拥有率的增加可能促成了2006 - 2010年间马拉维ACCM的下降，并且代表了对来自全国代表性调查的地区层面数据的一种新应用。
