title: Long-term effects of malaria prevention with insecticide-treated mosquito nets on morbidity and mortality in African children: randomised controlled trial.
abstract: OBJECTIVE
  The objective is to investigate the effect of malaria control with insecticide-treated mosquito nets (ITNs) regarding possible higher mortality in children protected during early infancy, due to interference with immunity development, and to assess long-term effects on malaria prevalence and morbidity.
  
  
  METHODS
  Between 2000 and 2002, a birth cohort was enrolled in 41 villages of a malaria holoendemic area in north-western Burkina Faso. All neonates (n = 3387) were individually randomised to ITN protection from birth (group A) vs. ITN protection from age 6 months (group B). Primary outcome was all-cause mortality. In 2009, a survey took place in six sentinel villages, and in 2010, a census was conducted in all study villages.
  
  
  RESULTS
  After a median follow-up time of 8.3 years, 443/3387 (13.1%) children had migrated out of the area and 484/2944 (16.4%) had died, mostly at home. Long-term compliance with ITN protection was good. There were no differences in mortality between study groups (248 deaths in group A, 236 deaths in group B; rate ratio 1.05, 95% CI: 0.889-1.237, P = 0.574). The survey conducted briefly after the rainy season in 2009 showed that more than 80% of study children carried asexual malaria parasites and up to 20% had clinical malaria.
  
  
  CONCLUSIONS
  Insecticide-treated mosquito net protection in early infancy is not a risk factor for mortality. Individual ITN protection does not sufficiently reduce malaria prevalence in high-transmission areas. Achieving universal ITN coverage remains a major challenge for malaria prevention in Africa.
authors.affiliation: Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Valérie R
authors.initials: VR
authors.lastname: Louis
authors.forename: Joëlle
authors.initials: J
authors.lastname: Bals
authors.forename: Justin
authors.initials: J
authors.lastname: Tiendrebéogo
authors.forename: Mamadou
authors.initials: M
authors.lastname: Bountogo
authors.forename: Heribert
authors.initials: H
authors.lastname: Ramroth
authors.forename: Manuela
authors.initials: M
authors.lastname: De Allegri
authors.forename: Corneille
authors.initials: C
authors.lastname: Traoré
authors.forename: Claudia
authors.initials: C
authors.lastname: Beiersmann
authors.forename: Boubacar
authors.initials: B
authors.lastname: Coulibaly
authors.forename: Maurice
authors.initials: M
authors.lastname: Yé
authors.forename: Albrecht
authors.initials: A
authors.lastname: Jahn
authors.forename: Heiko
authors.initials: H
authors.lastname: Becher
authors.forename: Olaf
authors.initials: O
authors.lastname: Müller
mesh_terms: D002050:Burkina Faso / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets; D007306:Insecticides / Q000276:immunology / Q000627:therapeutic use*; D008288:Malaria / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D008297:Male; D009032:Mosquito Control / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D016019:Survival Analysis; D013995:Time
chemical_list: D007306:Insecticides