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Use of an insecticide-treated net (ITN) is now the central focus for the Roll Back Malaria campaign, and disease-endemic countries have embarked on large-scale ITN distribution programs. We assessed the impact of an ITN social marketing program on clinical malaria in children less than five years of age. A case-control study was undertaken at Ndirande Health Center in the peri-urban area of the city of Blantyre, Malawi. Cases were defined by an axillary temperature 
37.5°C or a history of fever within the last 48 hours and a positive blood smear for Plasmodium falciparum. The individual effectiveness of ITN use was 40% (95% confidence interval [CI] = 10–60%) when cases were compared with clinic controls and 50% (95% CI = 0–60%) in comparison with community controls. With ITN coverage of 42%, the community effectiveness of this program was estimated to range from 17% to 21%. This represents 1,480 malaria cases averted by the intervention in a population of 15,000 children. Our results show that the benefits of ITN social marketing programs in reducing malaria are enormous. Targeting the poor could increase those benefits.
Received September 10, 2004. Accepted for publication March 14, 2005.
Acknowledgments: We thank the parents, caregivers, and all children involved in this study for their cooperation and participation. Dr. C. Mkandala (District Health Officer) and the staff of the Ndirande clinic provided critical support that made this study possible. We also thank the late Professor Tim Cullinan for making this study possible and Dr. Richard Steketee and Dr. Lawrence Marum (Centers for Disease Control and Prevention, Atlanta, GA) for supporting efforts to secure funding for this study.
Financial support: This work was supported by the Blantyre Integrated Malaria Initiative, a Centers for Disease Control and Prevention/U.S. Agency for International Development project in Malawi, a grant from Fogarty International Center of the National Institutes of Health (1 D43-TW00908), and the Global Health Program at the University of Michigan.
* Address correspondence to Mark L. Wilson, Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109-2029. E-mail: wilsonml{at}umich.edu
Authors’ addresses: Don P. Mathanga, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029 and Department of Community Health, University of Malawi, Private Bag 360, Blantyre 3, Malawi, E-mail: dmathang{at}umich.edu. Carl H. Campbell, Centers for Disease Control and Prevention Malaria Malawi Program (Ministry of Health/U.S. Agency for International Development/Centers for Disease Control and Prevention), Private Bag 240, Blantyre, Malawi, E-mail: ccampbell{at}cdcmalaria.org. Terrie E. Taylor, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824-1316, E-mail: taylor{at}msu.edu. Robin Barlow and Mark L. Wilson, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, E-mails: Bailwoe{at}aol.com and wilsonml{at}umich.edu.
Reprint requests: Mark L. Wilson, Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109-2029.
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