Duke Global Health Institute, Duke University, Durham, NC, USA.
Department of Geography, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
Sci Rep. 2018 Nov 20;8(1):17110. doi: 10.1038/s41598-018-35353-z.
Bed nets averted 68% of malaria cases in Africa between 2000 and 2015. However, concerns over insecticide resistance, bed net durability and the effectiveness of long-lasting insecticidal nets (LLIN) are growing. To assess the effectiveness of LLINs of different ages and insecticides against malaria, we conducted a population-based, cross-sectional study using data from 162,963 children younger than 5 years of age participating in 33 Demographic and Health and Malaria Indicator Surveys conducted in 21 countries between 2009 and 2016. We used Bayesian logistic regression to estimate associations between LLIN age, insecticide type, and malaria. Children sleeping under LLINs the previous night experienced 21% lower odds of malaria infection than children who did not (odds ratio [OR] 0.79; 95% Uncertainty Interval [UI] 0.76-0.82). Nets less than one year of age exhibited the strongest protective effect (OR 0.75; 95% UI 0.72-0.79), and protection weakened as net age increased. LLINs containing different insecticides exhibited similar protection (OR 0.78 [0.75-0.82]; OR 0.79 [0.75-0.83]; OR 0.85 [0.76-0.94]). Freely-available, population-based surveys can enhance and guide current entomological monitoring amid concerns of insecticide resistance and bed net durability, and be used with locally-collected data to support decisions on LLIN redistribution campaign timing which insecticide to use.
在 2000 年至 2015 年间，蚊帐使非洲的疟疾发病减少了 68%。然而，人们对杀虫剂耐药性、蚊帐耐久性以及长效杀虫剂处理蚊帐（LLIN）的有效性的担忧日益加剧。为了评估不同年代和杀虫剂处理的 LLIN 对疟疾的有效性，我们使用了来自 2009 年至 2016 年期间在 21 个国家进行的 33 次人口与健康和疟疾指标调查的数据，开展了一项基于人群的横断面研究。我们使用贝叶斯逻辑回归来评估 LLIN 年代、杀虫剂类型与疟疾之间的关联。在前一晚睡在 LLIN 下的儿童患疟疾的几率比未睡在 LLIN 下的儿童低 21%（比值比 [OR] 0.79；95%置信区间 [UI] 0.76-0.82）。使用不到一年的蚊帐的保护效果最强（OR 0.75；95% UI 0.72-0.79），随着蚊帐使用年限的增加，保护效果减弱。含有不同杀虫剂的 LLIN 表现出相似的保护效果（OR 0.78 [0.75-0.82]；OR 0.79 [0.75-0.83]；OR 0.85 [0.76-0.94]）。免费的基于人群的调查可以增强和指导当前的昆虫学监测，缓解人们对杀虫剂耐药性和蚊帐耐久性的担忧，并与当地收集的数据结合使用，支持有关 LLIN 重新分配运动时间和使用哪种杀虫剂的决策。
