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We assessed the proportion of febrile children less than five years old with prompt effective antimalarial treatment and the proportion of those less than five years old sleeping under insecticide-treated nets (ITNs) or any mosquito net the preceding night in African malarious countries. Data were reviewed from 23 Multiple Indicator Cluster Surveys and 13 Demographic and Health Surveys conducted between 1998 and 2002. A median of 53% of febrile children received antimalarial treatment. A median of 84% of these treatments, however, involved chloroquine, and the proportion of treatments given within two days of onset of symptoms was unknown in most surveys. Median coverages of those less than five years old with any net and ITNs were 15% and 2%, respectively. Use of nets, and especially ITNs, was consistently lower in rural than in urban areas. At the outset of intensified malaria control under Roll Back Malaria, coverage with principal interventions was far below the target of 60% set for Africa in 2005.
Received August 21, 2003. Accepted for publication November 15, 2003.
Acknowledgments: Roeland Monasch and Annette Reinisch oversaw the MICS surveys and conducted data analysis. Richard W. Steketee and Eline L. Korenromp reviewed data analysis and helped draft the report. David Alnwick and Yves Bergevin oversaw the data analysis. All authors participated in the writing and review of the report.
Financial support: The Demographic and Health Surveys were supported by the United States Agency for International Development. The Multiple Indicator Cluster Surveys were supported by the United Nations Children’s Fund. The analysis was supported by the participating agencies represented by the authors.
Authors’ addresses: Roeland Monasch and Yves Bergevin, Division of Policy and Planning, United Nations Children’s Fund, United Nations, 3 UN Plaza, New York, NY 10017. Annette Reinisch, Division of Policy and Planning, United Nations Children’s Fund, United Nations, 3 UN Plaza, New York, NY 10017 and Roll Back Malaria, World Health Organization, Geneva, Switzerland. Richard W. Steketee, Division of Parasitic Diseases, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30341. Eline L. Korenromp and David Alnwick, Malaria Control Department, Roll Back Malaria, World Health Organization, Avenue Appia 20, CH 1211, Geneva 27, Switzerland, Telephone: 41-22-791-1378/1329, Fax : 41-22-791-4824, E-mail: korenrompe{at}who.int.
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