REDUCTION OF CHILDHOOD MALARIA BY SOCIAL MARKETING OF INSECTICIDE-TREATED NETS: A CASE-CONTROL STUDY OF EFFECTIVENESS IN MALAWI

DON P. MATHANGA Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Community Health, College of Medicine, University of Malawi, Malawi; CDC Malaria Malawi Program, Centers for Disease Control and Prevention, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan

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CARL H. CAMPBELL Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Community Health, College of Medicine, University of Malawi, Malawi; CDC Malaria Malawi Program, Centers for Disease Control and Prevention, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan

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TERRIE E. TAYLOR Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Community Health, College of Medicine, University of Malawi, Malawi; CDC Malaria Malawi Program, Centers for Disease Control and Prevention, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan

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ROBIN BARLOW Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Community Health, College of Medicine, University of Malawi, Malawi; CDC Malaria Malawi Program, Centers for Disease Control and Prevention, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan

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MARK L. WILSON Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Community Health, College of Medicine, University of Malawi, Malawi; CDC Malaria Malawi Program, Centers for Disease Control and Prevention, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan

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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.

Author Notes

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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