title: Reduction of childhood malaria by social marketing of insecticide-treated nets: a case-control study of effectiveness in Malawi.
abstract: Use of an insecticide-treated net (ITN) is now the central focus for the Roll Back Malaria campaign, and disease-endemic countries have embarked on large-scale ITN distribution programs. We assessed the impact of an ITN social marketing program on clinical malaria in children less than five years of age. A case-control study was undertaken at Ndirande Health Center in the peri-urban area of the city of Blantyre, Malawi. Cases were defined by an axillary temperature > or = 37.5 degrees C or a history of fever within the last 48 hours and a positive blood smear for Plasmodium falciparum. The individual effectiveness of ITN use was 40% (95% confidence interval [CI] = 10-60%) when cases were compared with clinic controls and 50% (95% CI = 0-60%) in comparison with community controls. With ITN coverage of 42%, the community effectiveness of this program was estimated to range from 17% to 21%. This represents 1,480 malaria cases averted by the intervention in a population of 15,000 children. Our results show that the benefits of ITN social marketing programs in reducing malaria are enormous. Targeting the poor could increase those benefits.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA. dmathang@umich.edu
authors.forename: Don P
authors.initials: DP
authors.lastname: Mathanga
authors.forename: Carl H
authors.initials: CH
authors.lastname: Campbell
authors.forename: Terrie E
authors.initials: TE
authors.lastname: Taylor
authors.forename: Robin
authors.initials: R
authors.lastname: Barlow
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wilson
mesh_terms: D001512:Bedding and Linens; D016022:Case-Control Studies; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007306:Insecticides / Q000494:pharmacology*; D016778:Malaria, Falciparum / Q000517:prevention & control*; D008295:Malawi / Q000453:epidemiology; D009032:Mosquito Control; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D007306:Insecticides