ArticleBMJ global health2021
Effectiveness of a national mass distribution campaign of long-lasting insecticide-treated nets and indoor residual spraying on clinical malaria in Malawi, 2018-2020.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 41 citations in OpenAlex.
- Effectiveness and cost-effectiveness against malaria of three types of dual-active-ingredient long-lasting insecticidal nets (LLINs) compared with pyrethroid-only LLINs in Tanzania: a four-arm, cluster-randomised trial.Lancet (London, England) · 2022Trial
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- Anopheles gambiae biting behavior and malaria transmission risk in Simiw, a community located in the coastal forest zone of the Central Region of Ghana.Malaria journal · 2026Article
- The Malaria Vaccine Implementation Programme reduced clinical malaria in Kenya, 2020 to 2022 : Impact evaluation with predictive time-series models of routine surveillance data.Malaria journal · 2026Article
- Malaria outbreak facilitated by increased vector-breeding sites from erosion control pits sustained by intermittent rainfall, Mbale District, Uganda, January-June 2019.Malaria journal · 2025Article
- Inequity in the use of long-lasting insecticidal nets before and after nationwide mass distribution campaign in 48 districts of Uganda: VERSE toolkit analysis.BMC public health · 2025Article
- Evaluating the impact of two next-generation long-lasting insecticidal nets on malaria incidence in Uganda: an interrupted time-series analysis using routine health facility data.BMJ global health · 2025Article
- Process and Methodological Considerations for Observational Analyses of Vector Control Interventions in Sub-Saharan Africa Using Routine Malaria Data.The American journal of tropical medicine and hygiene · 2025Article
- An observational analysis of the impact of deltamethrin + piperonyl butoxide insecticide-treated nets on malaria case incidence and entomological indicators in Ebonyi State, Nigeria, 2017-2021.Malaria journal · 2024Observational
- Article
- Estimating the under-five malaria risk in Uganda based on the nearest neighbour matched analysis technique.African health sciences · 2024Article
- Elimination of lymphatic filariasis as a public health problem in Malawi.PLoS neglected tropical diseases · 2024Article
- Article
- How many mosquito nets are needed to maintain universal coverage: an update.Malaria journal · 2023Article
- The interplay between malaria vectors and human activity accounts for high residual malaria transmission in a Burkina Faso village with universal ITN coverage.Parasites & vectors · 2023Article
- Unravelling the impact of insecticide-treated bed nets on childhood malaria in Malawi.Malaria journal · 2023Article
- Two decades of malaria control in Malawi: Geostatistical Analysis of the changing malaria prevalence from 2000-2022.Wellcome open research · 2023Article
- Malawi ICEMR Malaria Research: Interactions and Results Influencing Health Policies and Practices.The American journal of tropical medicine and hygiene · 2022Article
- Routine use of DHIS2 data: a scoping review.BMC health services research · 2022Article
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Authors and funding
12 authors at 2 institutions in 2 countries.
Funding
Abstract
introductionMalawi's malaria burden is primarily assessed via cross-sectional national household surveys. However, malaria is spatially and temporally heterogenous and no analyses have been performed at a subdistrict level throughout the course of a year. The WHO recommends mass distribution of long-lasting insecticide-treated bed nets (LLINs) every 3 years, but a national longitudinal evaluation has never been conducted in Malawi to determine LLIN effectiveness lifespans.
methodsUsing District Health Information Software 2 (DHIS2) health facility data, available from January 2018 to June 2020, we assessed malaria risk before and after a mass distribution campaign, stratifying by age group and comparing risk differences (RDs) by LLIN type or annual application of indoor residual spraying (IRS).
results711 health facilities contributed 20 962 facility reports over 30 months. After national distribution of 10.7 million LLINs and IRS in limited settings, malaria risk decreased from 25.6 to 16.7 cases per 100 people from 2018 to 2019 high transmission seasons, and rebounded to 23.2 in 2020, resulting in significant RDs of -8.9 in 2019 and -2.4 in 2020 as compared with 2018. Piperonyl butoxide (PBO)-treated LLINs were more effective than pyrethroid-treated LLINs, with adjusted RDs of -2.3 (95% CI -2.7 to -1.9) and -1.5 (95% CI -2.0 to -1.0) comparing 2019 and 2020 high transmission seasons to 2018. Use of IRS sustained protection with adjusted RDs of -1.4 (95% CI -2.0 to -0.9) and -2.8% (95% CI -3.5 to -2.2) relative to pyrethroid-treated LLINs. Overall, 12 of 28 districts (42.9%) experienced increases in malaria risk in from 2018 to 2020.
conclusionLLINs in Malawi have a limited effectiveness lifespan and IRS and PBO-treated LLINs perform better than pyrethroid-treated LLINs, perhaps due to net repurposing and insecticide-resistance. DHIS2 provides a compelling framework in which to examine localised malaria trends and evaluate ongoing interventions.
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