MORTALITY AND MORBIDITY FROM MALARIA IN GAMBIAN CHILDREN AFTER INTRODUCTION OF AN IMPREGNATED BEDNET PROGRAM

After the success of a controlled trial of insecticide-treated bednets in lowering child mortality, The Gambia initiated a National Insectic ide Impregnated Bednet Programme (NlBP) in 1992 with the objective of introducing this form of malaria control into all large villages in Th e Gambia. Five areas (population 115 895) were chosen as sentinel site s for evaluation of the NlBP. During the first year of intervention a 25% reduction was achieved in ail-cause mortality in children 1-9 year s old living in treated villages (rate ratio 0.75 [95% CI 0.57-0.98], p=0.04). If one area where the programme was ineffective was excluded, the was 38% (0.62 [0.46-0.83), p=0.001). A in rates of parasitaemia a nd high-density parasitaemia, an increase in mean packed-cell volume ( rate ratio 0.75 [95% Cl 0.59-0.98], p=0.04) and an improvement in the nutritional status of children living in treated villages were also de tected. In a country such as The Gambia, where nets were widely used a nd which has a good primary health care system, it is possible to achi eve insecticide-treatment of bednets at a national level with a signif icant reduction in child mortality; but at a cost which the country ca nnot afford.