Effectiveness of Insecticide Treated Nets in Preventing Malaria in Sub-Saharan Africa

Presented by Sam Smith
Meredith College CSA Day 2020
#MeredithCSA
View the 2020 CSA Program Booklet at https://tinyurl.com/CSAProgramBooklet

Abstract:
The purpose of the project was to evaluate the indirect and direct protection conferred by community-level use of insecticide treated bed nets (ITNs) on occurrence of malaria in children under the age of five in sub-Saharan Africa. Whether ITN use protects the users themselves (i.e. direct protection), as well as community members that do not engage in ITN use (i.e. indirect protection) was evaluated. Publicly-available datasets were used from the Demographic and Health Survey program corresponding to four sub-Saharan countries that met a set of inclusion criteria for this study. Preliminary analyses identified confounding effects of household socioeconomic status, maternal education, urbanity, age of bednets, existence of standing water located near the respondents, and IRS use. For each country and corresponding year, the crude and adjusted odds ratios along with direct, indirect and total effects of ITN use were estimated. Neighborhood coverage levels of 25-50% and 50-100% and the use of an ITN prevented 2.9 (95% CI: 0.7-4.8) cases and 8.1 (95% CI: 4.8 -11.1) cases per 100 children under 5, respectively. The overall estimate of direct effects indicated that individuals who lived in a neighborhood coverage between 0-25% and 25-50% ITN coverage and were considered ITN users had a reduction of 2.9 malaria cases per 100 children compared to ITN non-users (95% CI: 0.9-4.7 and 0.7-4.8, respectively). Living in a neighborhood with 50-100% ITN coverage resulted in a reduction of 6.1 cases per 100 children for ITN non-users (95% CI: 2.7-9.7), supporting that there was significant indirect protection. Results for country and year specific data varied for total, direct, and indirect effects.