Malaria control--two years' use of insecticide-treated bednets compared with insecticide house spraying in KwaZulu-Natal


Mnzava, AE; Sharp, BL; Mthembu, DJ; le Sueur, D; Dlamini, SS; Gumede, JK; Kleinschmidt, I; (2001) Malaria control--two years' use of insecticide-treated bednets compared with insecticide house spraying in KwaZulu-Natal. South African Medical Journal, 91 (11). pp. 978-83. ISSN 0256-9574

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Abstract

OBJECTIVES: The objective of this study was to produce data indicating whether insecticide-treated bednets should replace insecticide house spraying as a malaria control method in South Africa. We report 2 years of preliminary data on malaria incidence comparing areas receiving insecticide-treated bednets and those subjected to house spraying in northern KwaZulu-Natal. DESIGN, SETTING AND SUBJECTS: In order to measure significant reductions in malaria incidence between the two interventions, a geographical information system (GIS) was used to identify and create seven pairs of geographical blocks (areas) in the malaria high-risk areas of Ndumu and Makanis in Ingwavuma magisterial district, KwaZulu-Natal. Individual blocks were then randomly allocated to either insecticide-treated bednets or house spraying with deltamethrin. Malaria cases were either routinely recorded by surveillance agents at home or were reported to the nearest health facility. RESULTS AND CONCLUSIONS: The results show that 2 years' use of insecticide-treated bednets by communities in Ndumu and Makanis, KwaZulu-Natal, significantly reduced the malaria incidence both in 1997 (rate ratio (RR) = 0.879, 95% confidence interval (CI) 0.80-0.95, P = 0.04) and in 1998 (RR = 0.667, CI 0.61-0.72, P = 0.0001). Using a t-test, these significant reductions were further confirmed by an assessment of the rate of change between 1996 and 1998, showing a 16% reduction in malaria incidence in blocks using treated bednets and an increase of 45% in sprayed areas (t = 2.534, P = 0.026 (12 df)). In order to decide whether bednets should replace house spraying in South Africa, we need more data on the efficacy of treated bednets, their long-term acceptability and the cost of the two interventions.

Item Type: Article
Keywords: Aerosols/economics/*therapeutic use, Animals, *Bedding and Linens, Culicidae/drug effects, Humans, Incidence, Insecticides/economics/*therapeutic use, Malaria/economics/epidemiology/*prevention & control, Mosquito Control/economics, Residence Characteristics, South Africa/epidemiology, Time Factors, Aerosols, economics, therapeutic use, Animals, Bedding and Linens, Culicidae, drug effects, Humans, Incidence, Insecticides, economics, therapeutic use, Malaria, economics, epidemiology, prevention & control, Mosquito Control, economics, Residence Characteristics, South Africa, epidemiology, Time Factors
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Malaria Centre
PubMed ID: 11847921
Web of Science ID: 173400900036
URI: http://researchonline.lshtm.ac.uk/id/eprint/9966

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