Department of Epidemiology, University of North Carolina, Gillings School of Global Public Health, 135 Dauer Drive, 3113 Michael Hooker Research Building, Chapel Hill, NC, 27599, USA.
Department of Geography, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA.
Malar J. 2018 Jan 18;17(1):39. doi: 10.1186/s12936-018-2183-y.
Understanding the contribution of community-level long-lasting, insecticidal net (LLIN) coverage to malaria control is critical to planning and assessing intervention campaigns. The Democratic Republic of Congo (DRC), which has one of the highest burdens of malaria cases and deaths and has dramatically scaled up LLIN ownership in recent years thus it is an ideal setting to evaluate the effect of individual versus community-level use to prevent malaria among children under the age of 5.
Data were derived from the 2013-2014 DRC Demographic and Health Survey. Community-level LLIN usage was significantly associated with protection against malaria, even when individual-level LLIN usage was included in the model. In stratified analysis, higher levels of community LLIN coverage enhanced the protective effect of individual LLIN usage, resulting in lower malaria prevalence among individuals who used a LLIN. A sub-analysis of individual LLIN usage by insecticide type revealed deltamethrin-treated nets were more protective than permethrin-treated nets, suggesting that mosquitoes in the DRC are more susceptible to deltamethrin.
This study examines the effects of individual and community-level LLIN usage in young children in an area of high ITN usage. Individual and community LLIN usage were significantly associated with protection against malaria in children under 5 in the DRC. Importantly, the protective effect of individual LLIN usage against malaria is enhanced when community LLIN coverage is higher, demonstrating the importance of increasing community-level LLIN usage. LLINs treated with deltamethrin were shown to be more protective against malaria than LLINs treated with permethrin. Demographic and Health Surveys are thus a novel and important means of surveillance for insecticide resistance.
了解社区层面长效驱虫蚊帐（LLIN）覆盖率对疟疾控制的贡献对于规划和评估干预措施至关重要。刚果民主共和国（DRC）是疟疾病例和死亡负担最高的国家之一，近年来 LLIN 拥有量大幅增加，因此是评估个体与社区层面使用 LLIN 预防 5 岁以下儿童疟疾效果的理想环境。
数据来自 2013-2014 年刚果民主共和国人口与健康调查。即使在模型中包含个体层面的 LLIN 使用情况，社区层面的 LLIN 使用情况仍与预防疟疾显著相关。分层分析表明，社区 LLIN 覆盖率越高，个体 LLIN 使用的保护作用越强，使用 LLIN 的个体中疟疾患病率越低。对个体 LLIN 使用的杀虫剂类型进行的亚分析表明，处理后的氯菊酯蚊帐比处理后的氯菊酯蚊帐更具保护作用，这表明刚果民主共和国的蚊子对氯菊酯更敏感。
本研究在 ITN 使用率较高的地区研究了个体和社区层面 LLIN 使用对幼儿的影响。个体和社区 LLIN 使用与 DRC 5 岁以下儿童预防疟疾显著相关。重要的是，当社区 LLIN 覆盖率较高时，个体 LLIN 使用对疟疾的保护作用增强，这表明提高社区层面 LLIN 使用的重要性。处理后的氯菊酯蚊帐比处理后的氯菊酯蚊帐更能预防疟疾。因此，人口与健康调查是监测杀虫剂抗性的一种新颖而重要的手段。
