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From efficacy to effectiveness: insecticide-treated bednets in Africa
1Tropical Health and Epidemiology Unit, London School of Hygiene and Tropical Medicine, England.
Bulletin of the World Health Organization
|January 1, 1996
Summary
Insecticide-treated bednets and curtains (ITBC) effectively reduce malaria in African children. Ongoing assessment is crucial to ensure sustained community-level effectiveness beyond trial conditions.
Area of Science:
- Public Health
- Tropical Medicine
- Vector Control
Background:
- Insecticide-treated bednets and curtains (ITBC) demonstrate high efficacy in reducing malaria morbidity and mortality in African children.
- Efficacy observed in trials may not fully translate to real-world program conditions, impacting cost-effectiveness and long-term impact assessments.
Purpose of the Study:
- To trace the history and assessment phases of ITBC, focusing on randomized controlled trials (Phase III).
- To outline the necessity for continued effectiveness assessment under program conditions (Phase IV).
- To propose a model for measuring ITBC effectiveness at both individual and community levels.
Main Methods:
- Review of ITBC history and assessment phases, including randomized controlled trials.
- Discussion of methodologies for measuring effectiveness under program conditions.
- Development of a conceptual framework differentiating individual and community effectiveness, utilizing case-control studies and coverage indicators.
Main Results:
- Direct measurement of ITBC effectiveness under program conditions is impractical.
- A model combining individual effectiveness (case-control study) with coverage indicators can estimate community effectiveness.
Conclusions:
- Continued assessment of ITBC effectiveness beyond initial trials is essential.
- A practical model exists to differentiate and measure individual and community effectiveness.
- This model can empower program managers to monitor health intervention impact at the community level.