Assessment of Effectiveness of Insecticide Treated Bednets for Malaria Prevention in Under-five Children of Aletawondo Woreda, Southern Ethiopia
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Date
2005-06
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Addis Abeba Universty
Abstract
Background: A Meta analysis of all randomized controlled trials showed that insecticide treated
net use has an overall protective efficacy against all -causes of child mortality and malaria disease
episodes of 18% and 50%, respectively. Frequent washing, lack of retreatment, inconsistent use,
other social and technical factors were shown to influence efficacy of bednets at field trials. To
date, however, experience with local factors influencing the effectiveness of ITN programs
remains very limited and it is not known whether the impact of treated nets in the context of well
controlled randomized trials can be replicated under program conditions in all set-ups.
Objective: To assess the effectiveness and influencing factors of ITNs in preventing clinical
malaria in under five children in Aletawondo Woreda, Sidama Zone, SNNPR.
Methods: A community based retrospective cohort study was conducted on a sample of 342
under five children (171 exposed and 171 unexposed/comparison group) residing in Chucko
Town & surrounding rural kebeles where there was ITN distribution. A precoded, pretested
structured questionnaire was employed to obtain the necessary information after getting both
written and verbal consent from the concerned bodies. The collected data was daily checked for
completeness and consistency and it was entered into computer database. An internal comparison
was also conducted to assess factors influencing effectiveness of bednets among those with
history of malaria (cases) and without history of the disease within the exposed cohort. Other
appropriate statistical tests were done and interpretations were made accordingly.
Result: The history of malaria attack from September to December 2004 among reported regular
ITNs users was 43.5% less than in those who didn't use/own bednet. This was statistically
significant (OR=0.565 95%CI 0.346-0.925 p=0.023). The household factors that were found
to influence the effectiveness of ITNs were large family size, keeping livestock inside living
room, using a bednet obtained a year or more, absence of retreatment of the bednet for more than
12 months, presence of hole/tears in the bednet, frequently washing the bednet and reported
history of rolling out of the child from the bednet during night time.
Conclusions & Recommendations: Despite lots of programmatic deficiencies, ITNs are
effective in preventing clinical malaria in under-five children. Based on these,
appropriate recommendations are forwarded.
Key Words: (Clinical malaria, Under -five child, Insecticide treated mosquito net
use, Effectiveness, retrospective cohort, nested case control Design,
Influencing household factor)
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Assessment of Effectiveness of Insecticide Treated