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Community Coverage with Insecticide-Treated Mosquito Nets and Observed Associations with All-Cause Child Mortality and Malaria Parasite Infections

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  • Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York; Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California; Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Global Health Group, University of California, San Francisco, California

Randomized trials and mathematical modeling suggest that insecticide-treated mosquito nets (ITNs) provide community-level protection to both those using ITNs and those without individual access. Using nationally representative household survey datasets from 17 African countries, we examined whether community ITN coverage is associated with malaria infections in children < 5 years old and all-cause child mortality (ACCM) among children < 5 years old in households with one or more ITNs versus without any type of mosquito net (treated or untreated). Increasing ITN coverage (> 50%) was protective against malaria infections and ACCM for children in households with an ITN, although this protection was not conferred to children in households without ITNs in these data. Children in households with ITNs were protected against malaria infections and ACCM with ITN coverage > 30%, but this protection was not significant with ITN coverage < 30%. Results suggest that ITNs are more effective with higher ITN coverage.

Author Notes

* Address correspondence to David A. Larsen, Department of Public Health, Food Studies and Nutrition, Syracuse University, 426 Ostrom Avenue, Syracuse, NY 13244. E-mail: dalarsen@syr.edu

Financial support: This research was funded by a subagreement with the Malaria Control and Evaluation Partnership in Africa (MACEPA), a PATH project with funding from the Bill and Melinda Gates Foundation.

Authors' addresses: David A. Larsen, Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, NY, and Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, E-mail: dalarsen@syr.edu. Paul Hutchinson and Philip Anglewicz, Department of Global Health Systems and Development, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, E-mails: phutchin@tulane.edu and panglewi@tulane.edu. Adam Bennett, Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, E-mail: bennetta2@globalhealth.ucsf.edu. Joshua Yukich, Joseph Keating, and Thomas P. Eisele, Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, E-mails: jyukich@tulane.edu, jkeating@tulane.edu, and teisele@tulane.edu.

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