Socially marketed insecticide-treated nets effectively reduce Plasmodium infection and anaemia among children in urban Malawi.
BACKGROUND
Use of insecticide-treated nets (ITNs) has become a central focus for the Roll Back Malaria campaign, and many countries in Africa have now embarked on large-scale public health programmes aimed at making ITNs available to those at greatest risk. However, the effectiveness of these programmes has rarely been evaluated.


METHODS
We conducted a cross-sectional survey to assess the impact of an ITN social marketing programme on Plasmodium falciparum infection and anaemia among children in urban Malawi.


RESULTS
Knowledge of ITNs was high; however, only 42% of the children surveyed reported to have used an ITN the previous night. Nevertheless, 17% (295/1721) of children had a positive P. falciparum smear at enrolment. Use of ITNs was associated with 52% protective efficacy against Plasmodium parasitemia. More than two-thirds of children were anaemic, yet the mean haemoglobin concentration was significantly higher in children using ITNs than in those not using nets. ITN use was associated with wealth, as poorer households were 60% less likely to use treated nets.


CONCLUSIONS
Although ITN social marketing programmes have the potential of improving malaria control and prevention, additional efforts are required to reach those for whom even subsidized nets are still too expensive.
Mathanga
Don P
DP
Department of Epidemiology, School of Public Health, The University of Michigan, Ann Arbor, MI, USA.
Campbell
Carl H
CH
Taylor
Terrie E
TE
Barlow
Robin
R
Wilson
Mark L
ML
D017677:Age Distribution; D000740:Anemia / Q000453:epidemiology / Q000517:prevention & control*; D001512:Bedding and Linens; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007306:Insecticides / Q000627:therapeutic use*; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D011203:Poverty; D011634:Public Health; D012307:Risk Factors; D040241:Social Marketing; D012959:Socioeconomic Factors; D014504:Urban Health
D006454:Hemoglobins; D007306:Insecticides