Nevill C G, Some E S, Mung'ala V O, Mutemi W, New L, Marsh K, Lengeler C, Snow R W
Clinical Research Centre, Kilifi Unit, Kenya Medical Research Institute (KEMRI), Kenya.
Trop Med Int Health. 1996 Apr;1(2):139-46. doi: 10.1111/j.1365-3156.1996.tb00019.x.
New tools to prevent malaria morbidity and mortality are needed to improve child survival in sub-Saharan Africa. Insecticide treated bednets (ITBN) have been shown, in one setting (The Gambia, West Africa), to reduce childhood mortality. To assess the impact of ITBN on child survival under different epidemiological and cultural conditions we conducted a community randomized, controlled trial of permethrin treated bednets (0.5 g/m2) among a rural population on the Kenyan Coast. Between 1991 and 1993 continuous community-based demographic surveillance linked to hospital-based in-patient surveillance identified all mortality and severe malaria morbidity events during a 2-year period among a population of over 11000 children under 5 years of age. In July 1993, 28 randomly selected communities were issued ITBN, instructed in their use and the nets re-impregnated every 6 months. The remaining 28 communities served as contemporaneous controls for the following 2 years, during which continuous demographic and hospital surveillance was maintained until the end of July 1995. The introduction of ITBN led to significant reductions in childhood mortality (PE 33%, CI 7-51%) and severe, life-threatening malaria among children aged 1-59 months (PE 44%, CI 19-62). These findings confirm the value of ITBN in improving child survival and provide the first evidence of their specific role in reducing severe morbidity from malaria.
为提高撒哈拉以南非洲地区儿童的存活率，需要有预防疟疾发病和死亡的新工具。在一个地区（西非的冈比亚），经杀虫剂处理的蚊帐已被证明可降低儿童死亡率。为评估经杀虫剂处理的蚊帐在不同流行病学和文化条件下对儿童存活率的影响，我们在肯尼亚海岸的农村人口中开展了一项关于氯菊酯处理蚊帐（0.5克/平方米）的社区随机对照试验。1991年至1993年期间，通过与医院住院监测相联系的持续社区人口监测，确定了11000多名5岁以下儿童在两年期间的所有死亡和严重疟疾发病事件。1993年7月，向28个随机挑选的社区发放了经杀虫剂处理的蚊帐，指导居民如何使用，并每6个月对蚊帐重新进行浸渍处理。其余28个社区在接下来的两年中作为同期对照，在此期间持续进行人口和医院监测，直至1995年7月底。经杀虫剂处理的蚊帐的引入使儿童死亡率显著降低（比例差33%，置信区间7%-51%），并使1至59个月大儿童中严重的、危及生命的疟疾显著减少（比例差44%，置信区间19%-62%）。这些研究结果证实了经杀虫剂处理的蚊帐在提高儿童存活率方面的价值，并首次证明了其在降低疟疾严重发病率方面的具体作用。
