Title
Longlasting insecticide treated bed nets confer indirect protective effects against malaria in subSaharan Africa,Used
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The purpose of the project was to evaluate the indirect and direct protection conferred by communitylevel use of insecticide treated bed nets (ITNs) on occurrence of malaria in children under the age of five in subSaharan Africa. A total of 32 336 children under five were included in this cross sectional study of publically available Malaria Indicator Survey data collected between 2009 and 2017. 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 50100% and the use of an ITN prevented 8.1 (95% CI: 4.8 11.1) cases per 100 children under 5, supporting the presence of protective total effects. The overall estimate of direct effects indicated that individuals who lived in a neighborhood coverage between 025% and 2550% ITN coverage and were considered ITN users had a reduction of 2.9 malaria cases per 100 children compared to ITN nonusers (95% CI: 0.94.7 and 0.74.8, respectively). Living in a neighborhood with 50100% ITN coverage resulted in a reduction of 6.1 cases per 100 children for ITN nonusers (95% CI: 2.79.7), supporting that there was significant indirect protection. Results for country and year specific data varied for total, direct, and indirect effects.
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