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. 2018 Jan 18;17(1):39.
doi: 10.1186/s12936-018-2183-y.

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

Lauren Levitz  1 , Mark Janko  2 , Kashamuka Mwandagalirwa  3 , Kyaw L Thwai  1 , Joris L Likwela  4 , Antoinette K Tshefu  3 , Michael Emch  2 , Steven R Meshnick  5
Affiliations

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

Lauren Levitz et al. Malar J. .

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.

Keywords: DRC; Democratic Republic of Congo; ITNs; Insecticide resistance; LLINs; Malaria; Mosquito nets; Under-fives.

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Figures

Fig. 1
Fig. 1
Enrollment criteria for study inclusion. A total of 9790 dried blood spots (DBS) were collected from children included in the second Demographic And Health Survey in the Democratic Republic of Congo (DHS-DRC II) from November 2013 to February 2014. A complete case analysis was performed on the 5857 samples from children ages 59 months or younger
Fig. 2
Fig. 2
Effect of LLIN insecticide type on PCR-positive malaria. LLINs were categorized by type of insecticide based on brand name as follows: deltamethrin (PermaNet, Yorkool LN, Lifenet, Serena, Netprotect); permethrin (Olyset); alpha-cypermethrin (Duranet, Magnet, Interceptor); or LLIN brand not specified. a Crude and adjusted (for age in months, housing index, maternal education, and altitude) odds ratios are presented by individual use of each LLIN type (versus no LLIN). Only deltamethrin-treated LLINs significantly reduced the odds of PCR-positive malaria in both the crude and adjusted models. b Number of subjects using each type of net and prevalence of malaria among them
See this image and copyright information in PMC

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