title: The use of insecticide-treated nets for reducing malaria morbidity among children aged 6-59 months, in an area of high malaria transmission in central Côte d'Ivoire.
abstract: BACKGROUND
  Long-lasting insecticidal nets (LLINs) are an important tool for controlling malaria. Much attention has been devoted to determine both the effect of LLINs on the reduction of Plasmodium infection rate and on clinically-confirmed malaria cases in sub-Saharan Africa. We carried out an epidemiological study to investigate whether LLINs impact on Plasmodium prevalence rate and the proportion of clinically-confirmed malaria cases, in five villages in the district of Toumodi, central Côte d'Ivoire.
  
  
  METHODS
  From April 2007 to November 2008, a community-based malaria control programme was implemented in the study villages, which involved large-scale distribution of LLINs, and training and sensitization activities within the community. We determined the effect of this programme on Plasmodium prevalence rate, clinically-confirmed malaria cases and proportion of high parasitaemia rates in children aged 6-59 months through a series of cross-sectional surveys starting in April 2007 and repeated once every 6 months.
  
  
  RESULTS
  We observed a significant decrease in the mean P. falciparum prevalence rate from April 2007 to April 2008 (p = 0.029). An opposite trend was observed from November 2007 to November 2008 when P. falciparum prevalence rate increased significantly (p = 0.003). Highly significant decreases in the proportions of clinical malaria cases were observed between April 2007 and April 2008 (p < 0.001), and between November 2007 and November 2008 (p = 0.001).
  
  
  CONCLUSIONS
  Large-scale distribution of LLINs, accompanied by training and sensitization activities, significantly reduced Plasmodium prevalence rates among young children in the first year of the project, whereas overall clinical malaria rates dropped over the entire 18-month project period. A decrease in community motivation to sleep under bed nets, perhaps along with changing patterns of malaria transmission, might explain the observed increase in the Plasmodium prevalence rate between November 2007 and November 2008.
authors.affiliation: Vector Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. g.b.koudou@liv.ac.uk.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Koudou
authors.forename: Hala
authors.initials: H
authors.lastname: Ghattas
authors.forename: Clémence
authors.initials: C
authors.lastname: Essé
authors.forename: Christian
authors.initials: C
authors.lastname: Nsanzabana
authors.forename: Fabian
authors.initials: F
authors.lastname: Rohner
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
authors.forename: Brian E
authors.initials: BE
authors.lastname: Faragher
authors.forename: Andres B
authors.initials: AB
authors.lastname: Tschannen