Mosquito Nets Provide Survival Benefit in Early Childhood and into Adulthood

1. In children, the use of mosquito nets for malaria control in early childhood was shown to be associated with increased survival benefits.

2. Mosquito net use in childhood was shown to be associated with substantial long-term benefits into adulthood.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Insecticide-treated nets have been a cornerstone of malaria control, as malaria is still a major cause of disease and death worldwide. As such, more than 46% of people at risk for malaria in sub-Saharan Africa sleep under a treated net. However, there is a gap in knowledge as to understanding the long-term survival benefits of using treated nets for children. This study found that there are substantial long-term benefits of childhood use of treated nets for malaria control, survival, and perhaps in developing functional immunity. This study was limited by the lack of individual follow-up between 2003 and 2019 and no information on children who died before the first study visit. Nevertheless, these study’s findings are significant, as they demonstrate that malaria control with treated nets in early childhood provides survival benefits that persist to adulthood.

Click to read the study in NEJM

Relevant Reading: Insecticide-Treated Nets and the Persistence of Childhood Survival Gains to Adulthood

In-Depth [prospective cohort study]: This 22-year prospective cohort study was conducted in rural southern Tanzania and followed 6706 participants. Patients who were born between January 1, 1998, and August 30, 2000, within the study area were eligible for the study. Patients who were born outside of this time window or who did not live in the studied regions were excluded from the study. The primary outcome measured was a survival that was verified during household visits, which was conducted every 4 months from 1998 through 2003, and from 2004 through 2015, it was recorded by routine Ifakara Rural Health and Demographic Surveillance Site visits (HDSS). In 2019, a final follow-up survey was conducted. The primary exposure variable was the use of nets between birth and 5 years of age. Outcomes in the primary analysis were assessed via Kaplan-Meier survival curves and Cox proportional hazards models. Based on reports of early-life community outreach visits, approximately one-quarter of children never slept under a treated net, one-half slept under a treated net some of the time, and the remaining quarter always slept under a treated net. Children who used treated nets at half the early-life visits or more had a hazard ratio for death of 0.57 (95% confidence interval [CI], 0.45 to 0.72) as compared to children who reported to have used treated nets at less than half the visits. Similarly, reported use of treated nets during at least half the early-life visits was associated with a hazard ratio for death of 0.93 (95% CI, 0.58 to 1.49) between 5 years and adulthood. Children who slept under a treated net were associated with a 40% lower risk of death (hazard ratio, 0.60; 95% CI, 0.47 to 0.76) even after adjusting for age, caregiver education, household income, year of birth, and the village of birth. Furthermore, each 10-percentage-point increase in early-life use of treated nets was associated with a 10% lower risk of death (hazard ratio, 0.90; 95% CI, 0.86 to 0.93). Overall, this study demonstrates that there is a significant long-term survival benefit when using insecticide-treated nets in early childhood.

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