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The effectiveness of older insecticide-treated bed nets (ITNs) to prevent malaria infection in an area of moderate pyrethroid resistance: results from a cohort study in Malawi.
Malaria Journal ( IF 3 ) Pub Date : 2020-01-15 , DOI: 10.1186/s12936-020-3106-2
Monica P Shah 1 , Laura C Steinhardt 1 , Dyson Mwandama 2 , Themba Mzilahowa 2 , John E Gimnig 3 , Andy Bauleni 2 , Jacklyn Wong 3 , Ryan Wiegand 1 , Don P Mathanga 2 , Kim A Lindblade 1
Affiliation  

BACKGROUND A previous cohort study in Malawi showed that users of new insecticide-treated bed nets (ITNs) were significantly protected against malaria compared to non-users, despite moderate levels of pyrethroid resistance among the primary mosquito vectors. The present study investigated whether ITNs that were 1-2 years old continued to protect users in the same area with moderate pyrethroid resistance. METHODS One year following a baseline cross-sectional malaria parasitaemia prevalence survey and universal distribution of deltamethrin ITNs (May 2012), a fixed cohort of 1223 children aged 6-59 months was enrolled (April 2013). Children were tested for parasitaemia at monthly scheduled visits and at unscheduled sick visits from May to December 2013 using rapid diagnostic tests. ITN use the prior night and the condition of ITNs (based on presence of holes) was assessed by caregiver self-report. The incidence rate ratio (RR) comparing malaria infection among users and non-users of ITNs was modelled using generalized estimating equations adjusting for potential confounders and accounting for repeated measures on each child. The protective efficacy (PE) of ITN use was calculated as 1 - RR. RESULTS In this cohort, self-reported ITN use remained consistently high (> 95%) over the study period. Although users of ITNs were slightly more protected compared to non-users of ITNs, the difference in incidence of infection was not statistically significant (RR 0.83, 95% confidence interval [CI] 0.54-1.27). Among ITN users, malaria incidence was significantly lower in users of ITNs with no holes (of any size) compared to users of ITNs with ≥ 1 hole (RR 0.82, 95% CI 0.69-0.98). CONCLUSIONS There was no significant PE of using 1-2 year-old ITNs on the incidence of malaria in children in an area of moderate pyrethroid resistance, but among ITN users, the authors found increased protection by ITNs with no holes compared to ITNs with holes. Given the moderate levels of pyrethroid resistance in the primary malaria vector and recent evidence of added benefits of ITNs with synergists or non-pyrethroid insecticides, next-generation ITNs may be a useful strategy to address pyrethroid resistance and should be further explored in Malawi.

中文翻译:

较老的经杀虫剂处理的蚊帐(ITN)在中等拟除虫菊酯抗性地区预防疟疾感染的有效性:马拉维一项队列研究的结果。

背景技术先前在马拉维进行的一项队列研究显示,与未使用蚊帐的蚊虫相比,使用新杀虫剂处理过的蚊帐(ITN)的蚊帐与未使用蚊帐的蚊帐相比,尽管未使用蚊虫对拟除虫菊酯的耐药性中等,但仍能有效预防疟疾。本研究调查了1-2岁的ITN是否继续以中等拟除虫菊酯抗性保护同一地区的使用者。方法在进行基线横断面疟疾寄生虫血症流行率调查和溴氰菊酯ITN普遍分布后一年(2012年5月),纳入了1223名6-59个月儿童的固定队列(2013年4月)。在2013年5月至2013年12月期间,使用快速诊断测试对儿童进行了寄生虫血症测试,每月进行一次定期探视,并在计划外的病假就诊。ITN使用前一晚,并由护理人员的自我报告评估ITN的状况(基于孔的存在)。使用针对潜在混杂因素进行调整并考虑到每个孩子的重复措施的广义估计方程,对在ITN使用者和非使用者之间比较疟疾感染的发生率比率(RR)进行建模。使用ITN的保护功效(PE)计算为1-RR。结果在该队列中,在研究期间,自我报告的ITN使用率始终保持较高(> 95%)。尽管与未使用ITN的用户相比,使用ITN的用户受到的保护要稍微多一些,但感染发生率的差异在统计学上并不显着(RR 0.83,95%置信区间[CI] 0.54-1.27)。在ITN用户中,与没有孔(≥1个)的ITN使用者相比,没有孔(任何大小)的ITN使用者的疟疾发病率显着降低(RR 0.82,95%CI 0.69-0.98)。结论在拟除虫菊酯抗药性中等的地区,使用1-2岁的ITN对儿童疟疾的发病率没有显着的PE,但在ITN使用者中,作者发现与没有孔的ITN相比,无孔的ITN增强了保护作用。 。鉴于主要疟疾媒介中的拟除虫菊酯抗药性处于中等水平,并且最近有证据表明ITN与增效剂或非拟除虫菊酯类杀虫剂具有更多的益处,因此下一代ITN可能是解决拟除虫菊酯抗药性的一种有用策略,应在马拉维进一步研究。结论在拟除虫菊酯抗药性中等的地区,使用1-2岁的ITN对儿童疟疾的发病率没有显着的PE,但在ITN使用者中,作者发现与没有孔的ITN相比,无孔的ITN增强了保护作用。 。鉴于主要疟疾媒介中的拟除虫菊酯抗药性处于中等水平,并且最近有证据表明ITN与增效剂或非拟除虫菊酯类杀虫剂具有更多的益处,因此下一代ITN可能是解决拟除虫菊酯抗药性的一种有用策略,应在马拉维进一步研究。结论在拟除虫菊酯抗药性中等的地区,使用1-2岁的ITN对儿童疟疾的发病率没有显着的PE,但在ITN使用者中,作者发现与没有孔的ITN相比,无孔的ITN增强了保护作用。 。鉴于主要疟疾媒介中的拟除虫菊酯抗药性处于中等水平,并且最近有证据表明ITN与增效剂或非拟除虫菊酯类杀虫剂具有更多的益处,因此下一代ITN可能是解决拟除虫菊酯抗药性的一种有用策略,应在马拉维进一步研究。
更新日期:2020-01-15
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