Pyrethroid-impregnated bed nets for personal protection against malaria for Afghan refugees

Abstract

A field trial of permethrin-impregnated bed nets (PIBs) was conducted in 2 Afghan refugee villages in Pakistan. Nets were issued to only 10% of families (= 1398 people); this simulated a situation in which bed nets are gradually adopted by villagers in Afghanistan. A further 10% lacking bed nets were selected as controls from the same villages. An initial survey showed that 86% of household heads were aware that malaria was transmitted by mosquito bites, but only 2% had used bed nets before. Trial families were encouraged to attend the village health centres if they fell ill. Microscopy records showed that, between July and December 1991, 22.4% of the control group became infected with Plasmodium vivax and 13.0% contracted P. falciparum while in the intervention group only 9.9% contracted P. vivax (relative risk 0.58, confidence interval [CI] 95% 0.49-0.68) and only 3.8% contracted P. falciparum (relative risk 0.39, 95% CI 0.29-0.53). A single treatment of the nets with permethrin at 0.5g/m2 remained protective throughout the 6 months' transmission season. 73% of families claimed to use their nets every night; members of families who claimed to use nets less regularly showed an incidence similar to that of the control group. There was no sex or age difference in net use or protective efficacy. Headlouse infestation rates were reduced in PIB users. Few nets were washed, given away or sold. The prospect for PIBs as personal protection appears good, despite people's lack of previous experience.

Community Coverage with Insecticide-Treated Mosquito Nets and Observed Associations with All-Cause Child Mortality and Malaria Parasite Infections

“…Previous studies by Hawley and others 4 and Rowland and others 22 failed to find a statistically significant communitylevel protection among children without ITNs when ITN coverage was 25% and 10%, respectively. We find no statistically significant community-level protection for children without ITNs when ITN coverage is as high as 70% compared with children in communities with 30% ITN coverage.…”

Malaria in camps for internally-displaced persons in Uganda: evaluation of an insecticide-treated bednet distribution programme

“…These two results are consistent with the 37% (95% CI 13-54%) reduction demonstrated in our study among ITN users versus non-users. There are few data on the effect of ITNs in refugee camps (Rowland et al, 1996) or IDP camps, which are estimated to concentrate more than 21 million people worldwide (USCR, 2000). In east Afghanistan, the year following resettlement, a reduction of 59% (95% CI 25-66%) in P. falciparum parasitaemia was observed among ITN users versus non-users (Rowland et al, 2002).…”

“…However, uncertainties remain about the effectiveness of ITNs when implemented in operational settings. To our knowledge, few studies have investigated the operational effectiveness of bednets (Armstrong Schellenberg et al, 2001;D'Alessandro et al, 1995;Guyatt et al, 2002;Maxwell et al, 2002), and very few data are available on the use of this control measure in camps for refugees or displaced persons (Dolan et al, 1993;Rowland et al, 1996Rowland et al, , 2002. We investigated this problem in Bundibugyo camps, an area of southwest Uganda experiencing recurrent insecurity, where the humanitarian organization Médecins Sans Frontières (MSF) works in collaboration with the Ugandan Ministry of Health (MoH) to provide health care for IDPs.…”

Resistance of falciparum malaria to chloroquine and sulfadoxine‐pyrimethamine in Afghan refugee settlements in western Pakistan: surveys by the general health services using a simplified in vivo test

“…Because hostilities have mostly ceased in eastern and southern Afghanistan, cross-border movement of adult males was frequent, leading to import and export of malaria. Women and children were much less mobile, and hence only a small proportion of malaria cases recorded in the BHUs was acquired in Afghanistan (Rowland et al 1996).…”