|Net Benefits: A Multicountry Analysis of Observational Data Examining Associations between Insecticidetreated Mosquito Nets and Health Outcomes|
||Stephen S. Lim, Nancy Fullman, Andrew Stokes, Nirmala Ravishankar, Felix Masiye, Christopher J. L.
||PLOS Medicine, 8(9): e1001091; doi:10.1371/journal.pmed.1001091
Insecticidetreated mosquito nets (ITNs)
Multiple African Countries
Background: Several sub-Saharan African countries have rapidly scaled up the number of households that own insecticidetreated
mosquito nets (ITNs). Although the efficacy of ITNs in trials has been shown, evidence on their impact under routine
conditions is limited to a few countries and the extent to which the scale-up of ITNs has improved population health
Methods and Findings: We used matched logistic regression to assess the individual-level association between household
ITN ownership or use in children under 5 years of age and the prevalence of parasitemia among children using six malaria
indicator surveys (MIS) and one demographic and health survey. We used Cox proportional hazards models to assess the
relationship between ITN household ownership and child mortality using 29 demographic and health surveys. The pooled
relative reduction in parasitemia prevalence from random effects meta-analysis associated with household ownership of at
least one ITN was 20% (95% confidence interval [CI] 3%–35%; I2 = 73.5%, p,0.01 for I2 value). Sleeping under an ITN was
associated with a pooled relative reduction in parasitemia prevalence in children of 24% (95% CI 1%–42%; I2 = 79.5%,
p,0.001 for I2 value). Ownership of at least one ITN was associated with a pooled relative reduction in mortality between 1
month and 5 years of age of 23% (95% CI 13–31%; I2 = 25.6%, p.0.05 for I2 value).
Conclusions: Our findings across a number of sub-Saharan African countries were highly consistent with results from
previous clinical trials. These findings suggest that the recent scale-up in ITN coverage has likely been accompanied by
significant reductions in child mortality and that additional health gains could be achieved with further increases in ITN
coverage in populations at risk of malaria.