Free Content Insecticide-treated bednets for the prevention of Plasmodium falciparum malaria in Cambodia: a cluster-randomized trial

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Abstract:

Summary Objectives 

To validate and quantify the impact of insecticide-treated bednets (ITN) on malaria morbidity and mortality in Cambodia. Methods 

A paired, cluster-randomized trial of ITN was conducted in Rattanakiri, North East Cambodia. Thirty-four villages with a total population of 10 726 were randomized to receive deltamethrin-impregnated bednets or to control (no net provision). Cross-sectional surveys measured Plasmodium falciparum prevalence at baseline and 10 months after ITN distribution. Village malaria volunteers in control and intervention villages treated dipstick-positive P. falciparum cases with artesunate and mefloquine. The resulting passive surveillance data were used as an estimate of the incidence of clinical P. falciparum infections. Results 

There was a protective efficacy of 28% in P. falciparum incidence (adjusted rate ratio 0.72, 95% CI 0.47–1.08) and 9% in P. falciparum prevalence (adjusted prevalence ratio 0.91, 95% CI 0.65–1.28) in ITN relative to control villages; however, neither of these estimates reached statistical significance. Individual-level analysis indicated a greater reduction in P. falciparum prevalence among under 5-year-olds (adjusted OR = 0.63, 95% CI 0.26–1.53) compared to older individuals (interaction P = 0.042). The protective efficacy of 35% (95% CI –28, 67%) with respect to clinical P. falciparum incidence in under 5-year-olds was more pronounced than the corresponding estimates for prevalence but was again not significant. Conclusions 

Lack of statistical significance in the results is likely to be due to a lack of power. The analysis provides further evidence for ITN effectiveness in South East Asia, particularly among individuals under 5 years of age.

Keywords: Cambodia; Plasmodium falciparum; bednet; insecticide; malaria; trial

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2006.01673.x

Affiliations: 1:  National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia 2:  VBDC Consulting Ltd, Llandysul, UK 3:  London School of Hygiene and Tropical Medicine, London, UK 4:  Provincial Health Department, Rattanakiri, Cambodia

Publication date: August 1, 2006

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