Ifakara Health Institute, Ifakara, Tanzania.
London School of Hygiene and Tropical Medicine, London, UK.
Malar J. 2023 Apr 25;22(1):134. doi: 10.1186/s12936-023-04560-z.
The effectiveness of insecticide-treated nets (ITNs) in preventing malaria in young children is well established. However, the long-term effects of early childhood ITN use on educational outcomes, fertility, and marriage in early adulthood are not well understood.
This study uses 22 years of longitudinal data from rural Tanzania to investigate the associations between early life ITN use and educational attainment, fertility and marriage in early adulthood. Unadjusted and adjusted logistic regression models were used to estimate the associations between early life ITN use and early adult outcomes (education, childbearing, and marriage), controlling for potential confounders, such as parental education, household asset quintiles, and year of birth. Analyses were conducted separately for men and women.
A total of 6706 participants born between 1998 and 2000 were enrolled in the study between 1998 and 2003. By 2019 a total of 604 had died and a further 723 could not be found, leaving 5379 participants who were interviewed, among whom complete data were available for 5216. Among women, sleeping under a treated net at least half of the time during early childhood ["high ITN use"] was associated with a 13% increase in the odds of completing primary school (adjusted odds ratio (aOR) 1.13 [0.85, 1.50]) and with a 40% increase in the odds of completing secondary school (aOR 1.40 [1.11, 1.76]) compared with women sleeping less frequently under ITNs in early life (< age 5 years). Among men, high ITN use was associated with a 50% increase in the odds of completing primary school (aOR 1.50 [1.18, 1.92]) and a 56% increase in the odds of completing secondary school (aOR 1.56 [1.16, 2.08]) compared to men with low ITN use in early life. Weaker associations were found between ITN use in early life and both adolescent childbearing (aOR 0.91 [0.75, 1.10]) and early marriage (aOR 0.86 [0.69, 1.05]).
This study found that early life use of ITNs was strongly associated with increased school completion in both men and women. More marginal associations were found between early-life ITN use and both marriage and child-bearing in early adulthood. ITN use during early childhood may have long-term positive effects on educational attainment in Tanzania. However, further research is needed to understand the mechanisms behind these associations and to explore the broader impacts of ITN use on other aspects of early adult life.
杀虫剂处理过的蚊帐（ITN）在预防儿童疟疾方面的有效性已得到充分证实。然而，儿童早期使用 ITN 对教育成果、生育和成年早期婚姻的长期影响还没有得到很好的理解。
本研究使用了来自坦桑尼亚农村的 22 年纵向数据，调查了儿童早期 ITN 使用与成年早期教育程度、生育和婚姻之间的关系。使用未调整和调整后的逻辑回归模型来估计儿童早期 ITN 使用与成年早期结果（教育、生育和婚姻）之间的关联，同时控制了潜在的混杂因素，如父母教育、家庭资产五分位数和出生年份。分析分别针对男性和女性进行。
共有 6706 名参与者于 1998 年至 2000 年期间出生，于 1998 年至 2003 年期间参加了研究。截至 2019 年，共有 604 人死亡，另有 723 人无法找到，共有 5379 名参与者接受了访谈，其中 5216 名参与者提供了完整的数据。在女性中，儿童早期至少一半时间睡在经过处理的蚊帐下（“高 ITN 使用”）与完成小学学业的几率增加 13%（调整后的优势比（aOR）1.13[0.85，1.50]）和完成中学学业的几率增加 40%（aOR 1.40[1.11，1.76]）相关，而在儿童早期 ITN 使用频率较低的女性中，完成小学学业的几率则较低。在男性中，高 ITN 使用与完成小学学业的几率增加 50%（aOR 1.50[1.18，1.92]）和完成中学学业的几率增加 56%（aOR 1.56[1.16，2.08]）相关，而在儿童早期 ITN 使用频率较低的男性中，完成小学学业的几率则较低。我们发现 ITN 在儿童早期的使用与青少年生育（aOR 0.91[0.75，1.10]）和早婚（aOR 0.86[0.69，1.05]）之间的关联较弱。
本研究发现，儿童早期使用 ITN 与男女的学业完成率呈高度相关。在儿童早期使用 ITN 与成年早期的婚姻和生育之间存在更微弱的关联。儿童早期使用 ITN 可能对坦桑尼亚的教育程度有长期的积极影响。然而，还需要进一步的研究来了解这些关联背后的机制，并探讨 ITN 使用对成年早期生活其他方面的更广泛影响。
