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The use of insecticide-treated bednets (ITBNs) has been shown to be effective in reducing mortality and morbidity from malaria. However, there is mixed evidence as to whether or not community-wide use of ITBNs engenders a 'mass effect', such that those not sleeping under bednets are offered protection from widespread ITBN use in the area in which they live. We have analysed data collected in Kilifi, Kenya, from a cohort of children followed from birth to investigate how the degree of net usage in the locality of a child affects the risk of developing malaria. This effect was explored using a Cox proportional hazards model. For those not using ITBNs, we found that an increasing level of ITBN usage within the area surrounding each child was associated with a decreasing risk of developing malaria, thus providing evidence in support of a mass community effect. The size and significance of this effect were found to decrease as non-overlapping areas of increasing distance away from a child's home were considered. The effect was significant for areas at distances of up to 1.5 km away from each child.

Original publication

DOI

10.1016/s0035-9203(00)90103-2

Type

Journal article

Journal

Transactions of the Royal Society of Tropical Medicine and Hygiene

Publication Date

07/2000

Volume

94

Pages

357 - 360

Addresses

Wellcome Trust Centre for the Epidemiology of Infectious Disease, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3FY, UK. sally.howard@ceid.ox.ac.uk

Keywords

Humans, Malaria, Pyrethrins, Permethrin, Insecticides, Incidence, Logistic Models, Proportional Hazards Models, Cohort Studies, Bedding and Linens, Mosquito Control, Child, Community Health Services, Kenya