Binka F N, Kubaje A, Adjuik M, Williams L A, Lengeler C, Maude G H, Armah G E, Kajihara B, Adiamah J H, Smith P G
Navrongo Health Research Centre, Ministry of Health, Ghana.
Trop Med Int Health. 1996 Apr;1(2):147-54. doi: 10.1111/j.1365-3156.1996.tb00020.x.
A community-based randomized, controlled trial of permethrin impregnated bednets was carried out in a rural area of northern Ghana, between July 1993 and June 1995, to assess the impact on the mortality of young children in an area of intense transmission of malaria and no tradition of bednet use. The district around Navrongo was divided into 96 geographical areas and in 48 randomly selected areas households were provided with permethrin impregnated bednets which were re-impregnated every 6 months. A longitudinal demographic surveillance system was used to record births, deaths and migrations, to evaluate compliance and to measure child mortality. The use of permethrin impregnated bednets was associated with 17% reduction in all-cause mortality in children aged 6 months to 4 years (RR = 0.83; 95% CI 0.69-1.00; P = 0.05). The reduction in mortality was confined to children aged 2 years of younger, and was greater in July-December, during the wet season and immediately after (RR = 0.79; 95% CI 0.63-1.00), a period when malaria mortality is likely to be increased, than in the dry season (RR = 0.92, 95% CI 0.73-1.14). The ready acceptance of bednets, the high level of compliance in their use and the subsequent impact on all-cause mortality in this study has important implications for programmes to control malaria in sub-Saharan Africa.
1993年7月至1995年6月期间，在加纳北部的一个农村地区开展了一项基于社区的氯菊酯浸渍蚊帐随机对照试验，以评估在疟疾高传播且无使用蚊帐传统的地区，其对幼儿死亡率的影响。纳瓦龙戈周边地区被划分为96个地理区域，在随机选取的48个区域，为家庭提供了每6个月重新浸渍一次的氯菊酯浸渍蚊帐。采用纵向人口监测系统记录出生、死亡和迁移情况，评估依从性并测量儿童死亡率。使用氯菊酯浸渍蚊帐使6个月至4岁儿童的全因死亡率降低了17%（相对危险度=0.83；95%置信区间0.69 - 1.00；P=0.05）。死亡率的降低仅限于2岁及以下儿童，且在7月至12月的雨季及之后（相对危险度=0.79；95%置信区间0.63 - 1.00），这一疟疾死亡率可能增加的时期，比旱季（相对危险度=0.92，95%置信区间0.73 - 1.14）更为明显。在本研究中，蚊帐易于被接受、使用依从性高以及随后对全因死亡率产生的影响，对于撒哈拉以南非洲的疟疾控制项目具有重要意义。
