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Unformatted text preview: 120 Bulletin of the World Health Organization | February 2006, 84 (2) Objective Insecticide-impregnated bednets and curtains have been shown by many studies to be effective against malaria. However, because of possible interactions with immunity development, treated bednets may cause no effect at all or even an increase in malaria morbidity and mortality in areas of high transmission. To clarify this issue, we did a randomized controlled trial to assess the long-term effects of bednet protection during early infancy. Methods A total of 3387 neonates from 41 villages in rural Burkina Faso were individually randomized to receive either bednet protection from birth (group A) or from age 6 months (group B). Primary outcomes were all-cause mortality in all study children and incidence of falciparum malaria in a representative subsample of the study population. Findings After a mean follow-up of 27 months, there were 129 deaths in group A and 128 deaths in group B rate ratio (RR) 1.0 (95% confidence interval (CI): 0.78–1.27)). Falciparum malaria incidence was lower in group A than in group B, during early (0–5 months) and late infancy (6–12 months) (RR 3.1, 95% CI: 2.0–4.9; RR 1.3, 95% CI: 1.1–1.6) and rates of moderate to severe anaemia were significantly lower during late infancy (11.5% vs 23.3%, P = 0.008), but there were no differences between groups in these parameters in children older than 12 months. Conclusion The findings from this study provide additional evidence for the efficacy of insecticide-treated nets in young children living in areas of intense malaria transmission. Keywords Malaria/in infancy and childhood/prevention and control/transmission; Bedding and linens; Mosquito control; Randomized controlled trials; Burkina Faso ( source: MeSH, NLM ). Mots clés Paludisme/chez le nourrisson et l’enfant/prévention et contrôle/transmission; Literie et linge; Lutte contre moustique; Essai clinique randomisé; Burkina Faso ( source: MeSH, INSERM ). Palabras clave Paludismo/en la infancia y la niñez/prevención y control/transmisión; Ropa de cama y ropa blanca; Control de mosquitos; Ensayos controlados aleatorios; Burkina Faso ( fuente: DeCS, BIREME ). Bulletin of the World Health Organization 2006;84:120-126. Voir page 125 le résumé en français. En la página 125 figura un resumen en español. Introduction Insecticide-impregnated bednets and curtains have consistently been shown to be effective in reducing malaria morbid- ity and all-cause mortality in children in various malaria endemic areas. 1 However, in recent years, controversy has emerged about the long-term consequences of protecting young children with impreg- nated nets and curtains in areas where transmission intensity (i.e., the frequency with which a person is exposed to infec- tive mosquito bites) is high. Because treated bednets and curtains prevent children from being bitten by mosquitos, a Department of Tropical Hygiene and Public Health, Ruprecht-Karls-University Heidelberg, INF 324, 69124 Heidelberg, Germany. Correspondence to Dr Müller Department of Tropical Hygiene and Public Health, Ruprecht-Karls-University Heidelberg, INF 324, 69124 Heidelberg, Germany....
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- Winter '06
- World Health Organization, Burkina Faso, falciparum malaria, malaria transmission, malaria morbidity