ArticleMalaria journal2017
The effect of holes in long-lasting insecticidal nets on malaria in Malawi: results from a case-control study.
Article in Malaria journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.
- Meta-analysis on the entomological effects of differentially treated ITNs in a multi-site experimental hut study in sub-Saharan Africa.Malaria journal · 2025Pooled it
- Trial
- Trial
- Comparative functional survival and equivalent annual cost of 3 long-lasting insecticidal net (LLIN) products in Tanzania: A randomised trial with 3-year follow up.PLoS medicine · 2020Trial
- Estimating the hole surface area of insecticide-treated nets using image analysis, manual hole counting and exact hole measurements.Malaria journal · 2025Article
- Article
- Impact of mass distribution of long-lasting insecticide nets on the incidence of malaria in Lomami, Democratic Republic of Congo: a study based on electronic health record data (2018 - 2019).The Pan African medical journal · 2023Observational
- Protective efficacy of holed and aging PBO-pyrethroid synergist-treated nets on malaria infection prevalence in north-western Tanzania.PLOS global public health · 2022Article
- Evaluation of the durability and use of long-lasting insecticidal nets in Nicaragua.Malaria journal · 2021Article
- Protective effects of Olyset® Net on Plasmodium falciparum infection after three years of distribution in western Kenya.Malaria journal · 2020Article
- The effectiveness of older insecticide-treated bed nets (ITNs) to prevent malaria infection in an area of moderate pyrethroid resistance: results from a cohort study in Malawi.Malaria journal · 2020Article
- Net age, but not integrity, may be associated with decreased protection against Plasmodium falciparum infection in southern Malawi.Malaria journal · 2019Article
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundLong-lasting insecticidal nets (LLINs) are a cornerstone of malaria prevention. Holes develop in LLINs over time and compromise their physical integrity, but how holes affect malaria transmission risk is not well known.
methodsAfter a nationwide mass LLIN distribution in July 2012, a study was conducted to assess the relationship between LLIN damage and malaria. From March to September 2013, febrile children ages 6-59 months who consistently slept under LLINs (every night for 2 weeks before illness onset) were enrolled in a case-control study at Machinga District Hospital outpatient department. Cases were positive for Plasmodium falciparum asexual parasites by microscopy while controls were negative. Digital photographs of participants' LLINs were analysed using an image-processing programme to measure holes. Total hole area was classified by quartiles and according to the World Health Organization's proportionate hole index (pHI) cut-offs [< 79 cm
resultsOf 248 LLINs analysed, 97 (39%) were from cases. Overall, 86% of LLINs had at least one hole. The median number of holes of any size was 9 [interquartile range (IQR) 3, 22], and most holes were located in the lower halves of the nets [median 7 (IQR 2, 16)]. There were no differences in number or location of holes between LLINs used by cases and controls. The median total hole area was 10 cm
conclusionsLLIN holes were not associated with increased odds of malaria in this study. However, most of the LLINs were in relatively good condition 1 year after distribution. Future studies should examine associations between LLIN holes and malaria risk with more damaged nets.
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Registered trials
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