Publication: The effect of insecticide-treated bed nets on the incidence and prevalence of malaria in children in an area of unstable seasonal transmission in western Myanmar
Accepted Date
2013-09-20
Issued Date
2013-10-11
Copyright Date
2013
Resource Type
Language
eng
ISSN
1475-2875 (electronic)
Rights
Mahidol University
Rights Holder(s)
BioMed Central
Bibliographic Citation
Smithuis FM, Kyaw MK, Phe UO, van der Broek I, Katterman N, Rogers C. et al. The effect of insecticide-treated bed nets on the incidence and prevalence of malaria in children in an area of unstable seasonal transmission in western Myanmar. Malar J. 2013 Oct 11;12:363.
Suggested Citation
Smithuis, Frank M., Kyaw, Moe Kyaw, Phe, U Ohn, van der Broek, Ingrid, Katterman, Nina, Rogers, Colin, Almeida, Patrick, Kager, Piet A., Stepniewska, Kasia, Lubell, Yoel, Simpson, Julie A., White, Nicholas J. The effect of insecticide-treated bed nets on the incidence and prevalence of malaria in children in an area of unstable seasonal transmission in western Myanmar. Smithuis FM, Kyaw MK, Phe UO, van der Broek I, Katterman N, Rogers C. et al. The effect of insecticide-treated bed nets on the incidence and prevalence of malaria in children in an area of unstable seasonal transmission in western Myanmar. Malar J. 2013 Oct 11;12:363.. doi:10.1186/1475-2875-12-363 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/762
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Title
The effect of insecticide-treated bed nets on the incidence and prevalence of malaria in children in an area of unstable seasonal transmission in western Myanmar
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Abstract
BACKGROUND: Insecticide-treated bed nets (ITN) reduce malaria morbidity and
mortality consistently in Africa, but their benefits have been less consistent in
Asia. This study's objective was to evaluate the malaria protective efficacy of
village-wide usage of ITN in Western Myanmar and estimate the cost-effectiveness
of ITN compared with extending early diagnosis and treatment services.
METHODS: A cluster-randomized controlled trial was conducted in Rakhine State to
assess the efficacy of ITNs in preventing malaria and anaemia in children and
their secondary effects on nutrition and development. The data were aggregated
for each village to obtain cluster-level infection rates. In total 8,175 children
under 10 years of age were followed up for 10 months, which included the main
malaria transmission period. The incidence and prevalence of Plasmodium
falciparum and Plasmodium vivax infections, and the biting behaviour of Anopheles
mosquitoes in the area were studied concurrently. The trial data along with costs
for current recommended treatment practices were modelled to estimate the
cost-effectiveness of ITNs compared with, or in addition to extending the
coverage of early diagnosis and treatment services.
RESULTS: In aggregate, malaria infections, spleen rates, haemoglobin
concentrations, and weight for height, did not differ significantly during the
study period between villages with and without ITNs, with a weighted mean
difference of -2.6 P. falciparum episodes per 1,000 weeks at risk (95% Confidence
Interval -7 to 1.8). In areas with a higher incidence of malaria there was some
evidence ITN protective efficacy. The economic analysis indicated that, despite
the uncertainty and variability in their protective efficacy in the different
study sites, ITN could still be cost-effective, but not if they displaced funding
for early diagnosis and effective treatment which is substantially more
cost-effective.
CONCLUSION: In Western Myanmar deployment of ITNs did not provide consistent
protection against malaria in children living in malaria endemic villages. Early
diagnosis and effective treatment is a more cost effective malaria control
strategy than deployment of ITNs in this area where the main vector bites early
in the evening, often before people are protected by an ITN.