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Malaria control – two years' use of insecticide treated bednets compared with insecticide house spraying in Kwazulu-Natal
Abstract
Objectives_ The objective of this study was to produce data indicating whether insecticide-treated bednets should replac insecticide house spraying as a malaria control method in South Africa_ We report 2 years of preliminary data on malaria incidence comparing areas receiving insecticidetreated bednets and those subjected to house spraying in northern KwaZulu-Natal.
Design, setting and subjects. In order to measure significant reductions in malaria incidence between the two interventions, a geographical information system (GIS) was used to identify and create seven pairs of geographical blood ; (areas) in the malaria high-risk areas of Ndumu and Makani in Ingwavuma magisterial district, KwaZulu-Natal, Individual blocks were then randomly allocated to either insecticide-treated bednets or house spraying with deltamethrin. Malaria cases were either routinely recorded by surveillance agents at home or were reported to the nearest health facility_
Results and conclusions. The results show that 2 years' use of insecticide-treated bednets by communities in Ndumu and Makanis, KwaZulu-Natal, significantly reduced the malaria incidence both in 1997 (rate ratio (RR) =0_879, 95% confidence interval (Cn 0.80 - 0.95, P =0.04) and in 1998 (RR = 0.667, Cl 0_61 - 0.72, P = 0.0001). Using a t-test, these significant reductions were further confirmed by an assessment of the rate of change between 1996 and 1998, showing a 16% reduction in malaria incidence in blocks using bednets and an increase of 45% in sprayed areas (t = 2.534, P = 0.026 (12 df». In order to decide whether bednets : should replace house spraying in South Africa, we need more : data on the efficacy of treated bednets, their long-term acceptability and the cost of the two interventions.
