Effect of individual and community-level bed net usage on malaria prevalence among under-fives in the Democratic Republic of Congo

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  • Levitz, Lauren
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Janko, Mark
    • Affiliation: College of Arts and Sciences, Department of Geography
  • Mwandagalirwa, Kashamuka
    • Other Affiliation: University of Kinshasa School of Public Health
  • Thwai, Kyaw L
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Likwela, Joris L
    • Other Affiliation: Programme National de la Lutte contre le Paludisme
  • Tshefu, Antoinette K
    • Other Affiliation: University of Kinshasa School of Public Health
  • Emch, Michael
    • Affiliation: College of Arts and Sciences, Department of Geography
  • Meshnick, Steven R.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Abstract Background Understanding the contribution of community-level long-lasting, insecticidal net (LLIN) coverage to malaria control is critical to planning and assessing intervention campaigns. The Democratic Republic of Congo (DRC), which has one of the highest burdens of malaria cases and deaths and has dramatically scaled up LLIN ownership in recent years thus it is an ideal setting to evaluate the effect of individual versus community-level use to prevent malaria among children under the age of 5. Results Data were derived from the 2013–2014 DRC Demographic and Health Survey. Community-level LLIN usage was significantly associated with protection against malaria, even when individual-level LLIN usage was included in the model. In stratified analysis, higher levels of community LLIN coverage enhanced the protective effect of individual LLIN usage, resulting in lower malaria prevalence among individuals who used a LLIN. A sub-analysis of individual LLIN usage by insecticide type revealed deltamethrin-treated nets were more protective than permethrin-treated nets, suggesting that mosquitoes in the DRC are more susceptible to deltamethrin. Conclusions This study examines the effects of individual and community-level LLIN usage in young children in an area of high ITN usage. Individual and community LLIN usage were significantly associated with protection against malaria in children under 5 in the DRC. Importantly, the protective effect of individual LLIN usage against malaria is enhanced when community LLIN coverage is higher, demonstrating the importance of increasing community-level LLIN usage. LLINs treated with deltamethrin were shown to be more protective against malaria than LLINs treated with permethrin. Demographic and Health Surveys are thus a novel and important means of surveillance for insecticide resistance.
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  • Article
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  • In Copyright
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  • The Author(s)
Journal title
  • Malaria Journal
Journal volume
  • 17
Journal issue
  • 1
Language
  • English
Bibliographic citation
  • Malaria Journal. 2018 Jan 18;17(1):39
Publisher
  • BioMed Central

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