CHANGES IN MALARIA ASSOCIATED MORBIDITY IN CHILDREN USING INSECTICIDETREATED MOSQUITO NETS IN THE BAGAMOYO DISTRICT OF COASTAL TANZANIA

A community based malaria control intervention using insecticide treat ed mosquito nets (IMN) has been implemented and tested in 13 villages of the Yombo Division, Bagamoyo District in the Coastal Region, Tanzan ia, an area holoendemic for P. falciparum malaria. Following extensive sociological research into local perceptions of malaria, the programm e was implemented. It was decided by consensus that village mosquito n et committees would be the appropriate local level implementers. These were formed and provided with IMN's which were sold to villagers at s ubsidised cost. The income was invested for use by the committees for sustaining the activity. Use patterns were determined and high coverag es were obtained among the community, particularly after promotions e. g. plays, school meetings etc. Malaria morbidity was measured among ch ildren 6-40 months of age in 7 index villages prior to the interventio n in 1992 and in a comparison study between 3 villages using nets and 4 villages not using nets in 1993. Examination of the 7 cohorts of chi ldren was done from June to October each year covering the period of m ost severe transmission. The children using nets showed marked improve ment in several malariometric indices. Following an initial clearance of parasitaemia with sulphadoxine/pyrimethamine, when compared with un protected children, those with nets were slower to become re-infected (Relative Risk 0.45), had lower parasitaemias and showed marked improv ement in anaemia (RR 0.47). use of IMN's produced a 54% reduction in t he prevalence of anaemia among young children. Attempts are being made to ensure that the programme is locally sustained.