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The degree of effectiveness of mosquito nets against malaria in the Americas has remained uncertain. We carried out a case-control study of net use and mild malaria in the Amazonas state of Colombia. Two hundred ninety cases were enrolled via the Health Department services, and 977 community-based controls matched for age, sex, and place of residence. We found that a large proportion of the population (96% of controls) slept under nets. Nevertheless, we found a benefit of impregnated nets compared with no net use: adjusted odds ratio (OR) for mild malaria 0.44, 95% confidence interval (CI) 0.20–0.98. Nonimpregnated nets had a benefit that was only slightly smaller but not statistically significant (OR for mild malaria 0.54, 95% CI 0.25–1.18). Travel in the previous month had an odds ratio of 6.2 (95% CI 3.1–8.8) and a population attributable fraction of 13% compared with 11% for failure to use an impregnated net. We conclude that, in the Amazon region, promotion of mosquito net use and impregnation is justified, and that there is a need for measures to protect travelers from malaria.
Received July 12, 2004. Accepted for publication January 24, 2005.
Acknowledgments: We are grateful to all residents of Tarapacá and the other two districts for their help and cooperation with the study; to Professor Chris Curtis for advice on the bioassays; and to Professor Jo Lines for advice on the running of the study and for comments on the manuscript.
Financial support: This work was supported by the United Kingdom Department for International Development, research project R7829, and the United Kingdom Medical Research Council grant number G7508177 to the Tropical Epidemiology Group.
* Address correspondence to Neal Alexander, Infectious Disease Epidemiology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. E-mail: neal.alexander{at}lshtm.ac.uk
Authors’ addresses: Neal Alexander and Andrew J. Hall, Infectious Disease Epidemiology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Mauricio Rodríguez, Ligia Pérez, Juan Carlos Caicedo, Jesús Cruz, Guillermo Prieto, José Antonio Arroyo, and Maria Cristina Cotacio, Secretaría de Salud del Amazonas, Carrera 11 #3-29, Leticia, Amazonas, Colombia. Martha Suárez, Universidad Nacional de Colombia, Vía Tarapacá Km 2 Leticia, Amazonas, Colombia. Fernando de la Hoz, Universidad Nacional de Colombia, Departamento de Salud Publica, Ciudad Universitaria, Cra 30, Calle 45 Bogotá, Colombia.
Reprint requests: Neal Alexander, Infectious Disease Epidemiology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Telephone: (+44) 20 7927 2483, Fax: (+44) 20 7636 8739, E-mail: neal.alexander{at}lshtm.ac.uk.
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