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Impact of mass distribution of free long-lasting insecticidal nets on childhood malaria morbidity: the Togo National Integrated Child Health Campaign.

Terlouw DJ, Morgah K, Wolkon A, Dare A, Dorkenoo A, Eliades MJ, Vanden Eng J, Sodahlon YK, ter Kuile FO, Hawley WA - Malar. J. (2010)

Bottom Line: Rainfall patterns were comparable in both years.The overall prevalence of moderate to severe anaemia (Hb<8.0 g/dL) was reduced by 28% (prevalence ratio [PR] 0.72, 95% CI 0.62-0.84) and mean haemoglobin was increased by 0.35 g/dL (95% CI 0.25-0.45).The effect was predominantly seen in children aged 18-59 months and in the two southern districts: PR (95% CI) for moderate to severe anaemia and clinical malaria: Yoto 0.62 (0.44-0.88) and 0.49 (0.35-0.75); Ogou 0.54 (0.37-0.79) and 0.85 (0.57-1.27), respectively.Similar reductions occurred in children<18 months in Ogou, but not in Yoto.

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Affiliation: Child and Reproductive Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. d.j.terlouw@liv.ac.uk

ABSTRACT

Background: An evaluation of the short-term impact on childhood malaria morbidity of mass distribution of free long-lasting insecticidal nets (LLINs) to households with children aged 9-59 months as part of the Togo National Integrated Child Health Campaign.

Methods: The prevalence of anaemia and malaria in children aged zero to 59 months was measured during two cross-sectional household cluster-sample surveys conducted during the peak malaria transmission, three months before (Sept 2004, n=2521) and nine months after the campaign (Sept 2005, n=2813) in three districts representative of Togo's three epidemiological malaria transmission regions: southern tropical coastal plains (Yoto), central fertile highlands (Ogou) and northern semi-arid savannah (Tone).

Results: In households with children<5 years of age, insecticide-treated net (ITN) ownership increased from <1% to >65% in all 3 districts. Reported ITN use by children during the previous night was 35.9%, 43.8% and 80.6% in Yoto, Ogou and Tone, respectively. Rainfall patterns were comparable in both years. The overall prevalence of moderate to severe anaemia (Hb<8.0 g/dL) was reduced by 28% (prevalence ratio [PR] 0.72, 95% CI 0.62-0.84) and mean haemoglobin was increased by 0.35 g/dL (95% CI 0.25-0.45).The effect was predominantly seen in children aged 18-59 months and in the two southern districts: PR (95% CI) for moderate to severe anaemia and clinical malaria: Yoto 0.62 (0.44-0.88) and 0.49 (0.35-0.75); Ogou 0.54 (0.37-0.79) and 0.85 (0.57-1.27), respectively. Similar reductions occurred in children<18 months in Ogou, but not in Yoto. No effect was seen in the semi-arid northern district despite a high malaria burden and ITN coverage.

Conclusions: A marked reduction in childhood malaria associated morbidity was observed in the year following mass distribution of free LLINs in two of the three districts in Togo. Sub-national level impact evaluations will contribute to a better understanding of the impact of expanding national malaria control efforts.

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2005, current ITN use by age and presence of a targeted sibling <5 years of age in the household. Current ITN use was defined as reported ITN use during the previous night with a hanging ITN in the household.
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Figure 2: 2005, current ITN use by age and presence of a targeted sibling <5 years of age in the household. Current ITN use was defined as reported ITN use during the previous night with a hanging ITN in the household.

Mentions: Before the campaign nets of any kind were reportedly present in 5% to 12.7% of the households in the three districts (Table 2). Less than 1% of children were reported to have slept under an ITN the previous night. Nine months after the campaign, net ownership and use had increased dramatically, with over 60% of the enrolled households reported to own an ITN in all three districts (Table 2). Households in Tone that owned a net were more likely to hang their net than households in Ogou or Yoto (95.4% versus 75.7% and 62.9%, respectively, p < 0.001). Young children <5 years of age were present in 80.0%, 73.3% and 72.3% of eligible households in Yoto, Ogou and Tone, respectively. Based on the coverage survey results the community household level coverage of hanging ITNs (thus including households without young children) at the time of the survey was estimated to be 34.5%, 44.1% and 67.2% in Yoto, Ogou and Tone, respectively. ITN use during the previous night in the pooled group of children aged 0 - 59 months of age varied considerably between the three districts in the post-campaign survey, with prevalences of 35.9%, 43.8% and 80.6% in Yoto, Ogou and Tone, respectively (Table 2). As the campaign only targeted children between nine to 59 months, and the post-intervention survey occurred nine months post-campaign, ITN use was also assessed by age group (Table 2) and presence of a sibling who had been eligible for the campaign (Figure 2). The use of an ITN was generally shared with other household members. Only 1.2% of children reportedly slept alone under an ITN. In 91.8% the mother reportedly slept with the child under the ITN, and 35% of children reportedly shared with both their mother and one or more siblings.


Impact of mass distribution of free long-lasting insecticidal nets on childhood malaria morbidity: the Togo National Integrated Child Health Campaign.

Terlouw DJ, Morgah K, Wolkon A, Dare A, Dorkenoo A, Eliades MJ, Vanden Eng J, Sodahlon YK, ter Kuile FO, Hawley WA - Malar. J. (2010)

2005, current ITN use by age and presence of a targeted sibling <5 years of age in the household. Current ITN use was defined as reported ITN use during the previous night with a hanging ITN in the household.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2914062&req=5

Figure 2: 2005, current ITN use by age and presence of a targeted sibling <5 years of age in the household. Current ITN use was defined as reported ITN use during the previous night with a hanging ITN in the household.
Mentions: Before the campaign nets of any kind were reportedly present in 5% to 12.7% of the households in the three districts (Table 2). Less than 1% of children were reported to have slept under an ITN the previous night. Nine months after the campaign, net ownership and use had increased dramatically, with over 60% of the enrolled households reported to own an ITN in all three districts (Table 2). Households in Tone that owned a net were more likely to hang their net than households in Ogou or Yoto (95.4% versus 75.7% and 62.9%, respectively, p < 0.001). Young children <5 years of age were present in 80.0%, 73.3% and 72.3% of eligible households in Yoto, Ogou and Tone, respectively. Based on the coverage survey results the community household level coverage of hanging ITNs (thus including households without young children) at the time of the survey was estimated to be 34.5%, 44.1% and 67.2% in Yoto, Ogou and Tone, respectively. ITN use during the previous night in the pooled group of children aged 0 - 59 months of age varied considerably between the three districts in the post-campaign survey, with prevalences of 35.9%, 43.8% and 80.6% in Yoto, Ogou and Tone, respectively (Table 2). As the campaign only targeted children between nine to 59 months, and the post-intervention survey occurred nine months post-campaign, ITN use was also assessed by age group (Table 2) and presence of a sibling who had been eligible for the campaign (Figure 2). The use of an ITN was generally shared with other household members. Only 1.2% of children reportedly slept alone under an ITN. In 91.8% the mother reportedly slept with the child under the ITN, and 35% of children reportedly shared with both their mother and one or more siblings.

Bottom Line: Rainfall patterns were comparable in both years.The overall prevalence of moderate to severe anaemia (Hb<8.0 g/dL) was reduced by 28% (prevalence ratio [PR] 0.72, 95% CI 0.62-0.84) and mean haemoglobin was increased by 0.35 g/dL (95% CI 0.25-0.45).The effect was predominantly seen in children aged 18-59 months and in the two southern districts: PR (95% CI) for moderate to severe anaemia and clinical malaria: Yoto 0.62 (0.44-0.88) and 0.49 (0.35-0.75); Ogou 0.54 (0.37-0.79) and 0.85 (0.57-1.27), respectively.Similar reductions occurred in children<18 months in Ogou, but not in Yoto.

View Article: PubMed Central - HTML - PubMed

Affiliation: Child and Reproductive Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. d.j.terlouw@liv.ac.uk

ABSTRACT

Background: An evaluation of the short-term impact on childhood malaria morbidity of mass distribution of free long-lasting insecticidal nets (LLINs) to households with children aged 9-59 months as part of the Togo National Integrated Child Health Campaign.

Methods: The prevalence of anaemia and malaria in children aged zero to 59 months was measured during two cross-sectional household cluster-sample surveys conducted during the peak malaria transmission, three months before (Sept 2004, n=2521) and nine months after the campaign (Sept 2005, n=2813) in three districts representative of Togo's three epidemiological malaria transmission regions: southern tropical coastal plains (Yoto), central fertile highlands (Ogou) and northern semi-arid savannah (Tone).

Results: In households with children<5 years of age, insecticide-treated net (ITN) ownership increased from <1% to >65% in all 3 districts. Reported ITN use by children during the previous night was 35.9%, 43.8% and 80.6% in Yoto, Ogou and Tone, respectively. Rainfall patterns were comparable in both years. The overall prevalence of moderate to severe anaemia (Hb<8.0 g/dL) was reduced by 28% (prevalence ratio [PR] 0.72, 95% CI 0.62-0.84) and mean haemoglobin was increased by 0.35 g/dL (95% CI 0.25-0.45).The effect was predominantly seen in children aged 18-59 months and in the two southern districts: PR (95% CI) for moderate to severe anaemia and clinical malaria: Yoto 0.62 (0.44-0.88) and 0.49 (0.35-0.75); Ogou 0.54 (0.37-0.79) and 0.85 (0.57-1.27), respectively. Similar reductions occurred in children<18 months in Ogou, but not in Yoto. No effect was seen in the semi-arid northern district despite a high malaria burden and ITN coverage.

Conclusions: A marked reduction in childhood malaria associated morbidity was observed in the year following mass distribution of free LLINs in two of the three districts in Togo. Sub-national level impact evaluations will contribute to a better understanding of the impact of expanding national malaria control efforts.

Show MeSH
Related in: MedlinePlus