title: Impact of promoting longer-lasting insecticide treatment of bed nets upon malaria transmission in a rural Tanzanian setting with pre-existing high coverage of untreated nets.
abstract: BACKGROUND
  The communities of Namawala and Idete villages in southern Tanzania experienced extremely high malaria transmission in the 1990s. By 2001-03, following high usage rates (75% of all age groups) of untreated bed nets, a 4.2-fold reduction in malaria transmission intensity was achieved. Since 2006, a national-scale programme has promoted the use of longer-lasting insecticide treatment kits (consisting of an insecticide plus binder) co-packaged with all bed nets manufactured in the country.
  
  
  METHODS
  The entomological inoculation rate (EIR) was estimated through monthly surveys in 72 houses randomly selected in each of the two villages. Mosquitoes were caught using CDC light traps placed beside occupied bed nets between January and December 2008 (n = 1,648 trap nights). Sub-samples of mosquitoes were taken from each trap to determine parity status, sporozoite infection and Anopheles gambiae complex sibling species identity.
  
  
  RESULTS
  Compared with a historical mean EIR of approximately 1400 infectious bites/person/year (ib/p/y) in 1990-94; the 2008 estimate of 81 ib/p/y represents an 18-fold reduction for an unprotected person without a net. The combined impact of longer-lasting insecticide treatments as well as high bed net coverage was associated with a 4.6-fold reduction in EIR, on top of the impact from the use of untreated nets alone. The scale-up of bed nets and subsequent insecticidal treatment has reduced the density of the anthropophagic, endophagic primary vector species, Anopheles gambiae sensu stricto, by 79%. In contrast, the reduction in density of the zoophagic, exophagic sibling species Anopheles arabiensis was only 38%.
  
  
  CONCLUSIONS
  Insecticide treatment of nets reduced the intensity of malaria transmission in addition to that achieved by the untreated nets alone. Impacts were most pronounced against the highly anthropophagic, endophagic primary vector, leading to a shift in the sibling species composition of the A. gambiae complex.
authors.affiliation: Biomedical and Environmental Thematic Group, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania. t.russell2@uq.edu.au
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Russell
authors.forename: Dickson W
authors.initials: DW
authors.lastname: Lwetoijera
authors.forename: Deodatus
authors.initials: D
authors.lastname: Maliti
authors.forename: Beatrice
authors.initials: B
authors.lastname: Chipwaza
authors.forename: Japhet
authors.initials: J
authors.lastname: Kihonda
authors.forename: J Derek
authors.initials: JD
authors.lastname: Charlwood
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Smith
authors.forename: Christian
authors.initials: C
authors.lastname: Lengeler
authors.forename: Mathew A
authors.initials: MA
authors.lastname: Mwanyangala
authors.forename: Rose
authors.initials: R
authors.lastname: Nathan
authors.forename: Bart Gj
authors.initials: BG
authors.lastname: Knols
authors.forename: Willem
authors.initials: W
authors.lastname: Takken
authors.forename: Gerry F
authors.initials: GF
authors.lastname: Killeen
mesh_terms: D000818:Animals; D000852:Anopheles / Q000145:classification / Q000469:parasitology*; D004772:Entomology; D005247:Feeding Behavior; D006801:Humans; D007299:Insect Bites and Stings; D057148:Insecticide-Treated Bednets; D007306:Insecticides; D008288:Malaria / Q000469:parasitology / Q000517:prevention & control* / Q000635:transmission*; D009032:Mosquito Control / Q000379:methods*; D012111:Residence Characteristics; D012189:Retrospective Studies; D012424:Rural Population; D013636:Tanzania; D013997:Time Factors
chemical_list: D007306:Insecticides