title: Effects of insecticide-treated bednets during early infancy in an African area of intense malaria transmission: a randomized controlled trial.
abstract: 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Tropical Hygiene and Public Health, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany. olaf.mueller@urz.uni-heidelberg.de
authors.forename: Olaf
authors.initials: O
authors.lastname: Müller
authors.forename: Corneille
authors.initials: C
authors.lastname: Traoré
authors.forename: Bocar
authors.initials: B
authors.lastname: Kouyaté
authors.forename: Yazoumé
authors.initials: Y
authors.lastname: Yé
authors.forename: Claudia
authors.initials: C
authors.lastname: Frey
authors.forename: Boubacar
authors.initials: B
authors.lastname: Coulibaly
authors.forename: Heiko
authors.initials: H
authors.lastname: Becher
mesh_terms: D000367:Age Factors; D001512:Bedding and Linens / Q000600:supply & distribution*; D002050:Burkina Faso / Q000453:epidemiology; D002423:Cause of Death; D019353:Endemic Diseases / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007306:Insecticides; D016778:Malaria, Falciparum / Q000401:mortality* / Q000469:parasitology / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods*; D011159:Population Surveillance; D015397:Program Evaluation; D012423:Rural Health
chemical_list: D007306:Insecticides