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. 2017 Sep;97(3_Suppl):65-75.
doi: 10.4269/ajtmh.15-0929.

Impact of Insecticide-Treated Net Ownership on All-Cause Child Mortality in Malawi, 2006-2010

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Free PMC article

Impact of Insecticide-Treated Net Ownership on All-Cause Child Mortality in Malawi, 2006-2010

Lia S Florey et al. Am J Trop Med Hyg. .
Free PMC article

Abstract

Insecticide-treated nets (ITNs) have been shown to be highly effective at reducing malaria morbidity and mortality in children. However, there are limited studies that assess the association between increasing ITN coverage and child mortality over time, at the national level, and under programmatic conditions. Two analytic approaches were used to examine this association: a retrospective cohort analysis of individual children and a district-level ecologic analysis. To evaluate the association between household ITN ownership and all-cause child mortality (ACCM) at the individual level, data from the 2010 Demographic and Health Survey (DHS) were modeled in a Cox proportional hazards framework while controlling for numerous environmental, household, and individual confounders through the use of exact matching. To evaluate population-level association between ITN ownership and ACCM between 2006 and 2010, program ITN distribution data and mortality data from the 2006 Multiple Indicator Cluster Survey and the 2010 DHS were aggregated at the district level and modeled using negative binomial regression. In the Cox model controlling for household, child and maternal health factors, children between 1 and 59 months in households owning an ITN had significantly lower mortality compared with those without an ITN (hazard ratio = 0.75, 95% confidence interval [CI] = 0.62-90). In the district-level model, higher ITN ownership was significantly associated with lower ACCM (incidence rate ratio = 0.77; 95% CI = 0.60-0.98). These findings suggest that increasing ITN ownership may have contributed to the decline in ACCM during 2006-2010 in Malawi and represent a novel use of district-level data from nationally representative surveys.

Figures

Figure 1.
Figure 1.
Hazard function by household insecticide-treated net status.
Figure 2.
Figure 2.
Annual all-cause under-five mortality rate for Malawi. (A) From 1990–2010; (B) From 2006–2010. IGME = UN Inter-agency Group for Child Mortality Estimation.
Figure 3.
Figure 3.
Household ownership of insecticide-treated nets by district, 2006–2010.
Figure 4.
Figure 4.
Annual district-level insecticide-treated net (ITN) coverage estimated from ITN ownership data from national surveys and from ITN distribution data adjusted for population and a decay factor, 2006–2010.

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