Impact of a large scale insecticide treated nets (ITNs) program on malaria in Malawian children.

Abstract

Recent randomized trials have demonstrated the efficacy of Insecticide Treated Nets (ITNs) in preventing malaria morbidity and mortality in African children. Despite this evidence of efficacy, the effectiveness of ITNs on morbidity and mortality in an actual program setting remains circumspect. The strict trial conditions (high coverage and compliance), under which efficacy has been estimated do not resemble the conditions under which malaria control programs are delivered in developing countries. Therefore, the transition from efficacy to effectiveness requires careful evaluation. Accordingly, this dissertation evaluated the impact of a large-scale ITN social marketing program on malaria morbidity. An additional aim of the study was to determine the cost-effectiveness of distributing ITNs through a social marketing program. A community-based cross sectional survey and a case-control study were used to determine the impacts of socially-marketed ITNs on <italic>Plasmodium falciparum </italic> infection, anemia and malaria illness. Another resource input study was used to collect information on costs associated with Blantyre Insecticide Treated Net (BITNET) project over a period of one year. Results from these studies show that 41% of the children were using ITNs in the area and that ownership, and use of ITNs were associated with household socioeconomic status. ITN use was associated with 52% protective efficacy from malaria infection and status. ITN use was associated with 52% protective efficacy from malaria infection and 40% protective efficacy from malaria illness. Furthermore, ITN users had higher hemoglobin levels than non-users. The ITN social marketing program, at a cost of $72.40 per DALY gained was a cost-effective way of distributing ITNs. Our results demonstrate that ITNs are effective even in areas where resources to distribute ITNs were scarce and coverage was low. However, even though social marketing programs have tremendous potential in controlling malaria, efforts should be made to find other means of distributing ITNs to the poor, who are clearly discriminated against by social marketing programs.