title: Impact of mass distribution of free long-lasting insecticidal nets on childhood malaria morbidity: the Togo National Integrated Child Health Campaign.
abstract: BACKGROUND
  An evaluation of the short-term impact on childhood malaria morbidity of mass distribution of free long-lasting insecticidal nets (LLINs) to households with children aged 9-59 months as part of the Togo National Integrated Child Health Campaign.
  
  
  METHODS
  The prevalence of anaemia and malaria in children aged zero to 59 months was measured during two cross-sectional household cluster-sample surveys conducted during the peak malaria transmission, three months before (Sept 2004, n=2521) and nine months after the campaign (Sept 2005, n=2813) in three districts representative of Togo's three epidemiological malaria transmission regions: southern tropical coastal plains (Yoto), central fertile highlands (Ogou) and northern semi-arid savannah (Tone).
  
  
  RESULTS
  In households with children<5 years of age, insecticide-treated net (ITN) ownership increased from <1% to >65% in all 3 districts. Reported ITN use by children during the previous night was 35.9%, 43.8% and 80.6% in Yoto, Ogou and Tone, respectively. Rainfall patterns were comparable in both years. The overall prevalence of moderate to severe anaemia (Hb<8.0 g/dL) was reduced by 28% (prevalence ratio [PR] 0.72, 95% CI 0.62-0.84) and mean haemoglobin was increased by 0.35 g/dL (95% CI 0.25-0.45).The effect was predominantly seen in children aged 18-59 months and in the two southern districts: PR (95% CI) for moderate to severe anaemia and clinical malaria: Yoto 0.62 (0.44-0.88) and 0.49 (0.35-0.75); Ogou 0.54 (0.37-0.79) and 0.85 (0.57-1.27), respectively. Similar reductions occurred in children<18 months in Ogou, but not in Yoto. No effect was seen in the semi-arid northern district despite a high malaria burden and ITN coverage.
  
  
  CONCLUSIONS
  A marked reduction in childhood malaria associated morbidity was observed in the year following mass distribution of free LLINs in two of the three districts in Togo. Sub-national level impact evaluations will contribute to a better understanding of the impact of expanding national malaria control efforts.
authors.affiliation: Child and Reproductive Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. d.j.terlouw@liv.ac.uk
authors.forename: Dianne J
authors.initials: DJ
authors.lastname: Terlouw
authors.forename: Kodjo
authors.initials: K
authors.lastname: Morgah
authors.forename: Adam
authors.initials: A
authors.lastname: Wolkon
authors.forename: Aboudou
authors.initials: A
authors.lastname: Dare
authors.forename: Ameyo
authors.initials: A
authors.lastname: Dorkenoo
authors.forename: M James
authors.initials: MJ
authors.lastname: Eliades
authors.forename: Jodi
authors.initials: J
authors.lastname: Vanden Eng
authors.forename: Yao K
authors.initials: YK
authors.lastname: Sodahlon
authors.forename: Feiko O
authors.initials: FO
authors.lastname: ter Kuile
authors.forename: William A
authors.initials: WA
authors.lastname: Hawley
mesh_terms: D000740:Anemia / Q000453:epidemiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets; D007306:Insecticides; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D008297:Male; D009017:Morbidity; D009032:Mosquito Control / Q000379:methods*; D010067:Ownership / Q000706:statistics & numerical data*; D015995:Prevalence; D014037:Togo / Q000453:epidemiology
chemical_list: D007306:Insecticides