DO INSECTICIDE-TREATED CURTAINS REDUCE ALL-CAUSE CHILD-MORTALITY IN BURKINA-FASO

To evaluate whether insecticide-treated netting (ITN) reduces child mo rtality in different epidemiological settings, 4 large, randomized, co ntrolled trials were conducted in Africa. Here we report the findings from the trial in Burkina Faso, in an area of hyperendemic and markedl y seasonal malaria transmission. The trial involved 158 villages, with a total population of some 90,000, grouped into 16 geographical clust ers. Ascertainment of mortality among children aged 6-59 months began in early 1993. In June/July 1994, 8 Of the clusters, randomly selected , received permethrin-treated curtains. Follow-up of children and asce rtainment of mortality continued until May 1996. A 15% reduction in al l-cause mortality among children aged 6-59 months was observed over th e 2-year period following the installation of the curtains (95% c.i. - 4% to 30%) In the first year, post-intervention mortality was substan tially lower in the clusters receiving curtains compared with the cont rol clusters (rate ratio = 0.74; 95% c.i. 0.57, 0.95) but in the secon d year, there was no difference between mortality in the two groups (r ate ratio = 0.99). The overall two-year impact of the intervention is consistent with the impacts observed in other trials which have demons trated reductions in child mortality of from 17% to 33% However, the y ear-by-year analysis raises some concerns about the long-term effect o f ITN. Further follow-up of this population is warranted.