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Interactions between Age and ITN Use Determine the Risk of Febrile Malaria in Children

BACKGROUND: Control measures which reduce individual exposure to malaria are expected to reduce disease, but also to eventually reduce immunity. Reassuringly, long term data following community wide ITN distribution show sustained benefits at a population level. However, the more common practice in...

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Autores principales: Bejon, Philip, Ogada, Edna, Peshu, Norbert, Marsh, Kevin
Formato: Texto
Lenguaje:English
Publicado: Public Library of Science 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792723/
https://www.ncbi.nlm.nih.gov/pubmed/20037643
http://dx.doi.org/10.1371/journal.pone.0008321
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author Bejon, Philip
Ogada, Edna
Peshu, Norbert
Marsh, Kevin
author_facet Bejon, Philip
Ogada, Edna
Peshu, Norbert
Marsh, Kevin
author_sort Bejon, Philip
collection PubMed
description BACKGROUND: Control measures which reduce individual exposure to malaria are expected to reduce disease, but also to eventually reduce immunity. Reassuringly, long term data following community wide ITN distribution show sustained benefits at a population level. However, the more common practice in Sub-Saharan Africa is to target ITN distribution on young children. There are few data on the long term outcomes of this practice. METHODOLOGY/PRINCIPAL FINDINGS: Episodes of febrile malaria were identified by active surveillance in 383 children over 18 months of follow up. In order to compare the short and long term outcomes of ITN use, we examined interactions between ITN use and age (12–42 months of age versus 42–80 months) in determining the risk of febrile malaria. ITN use and older age protected against the first or only episode of malaria (Hazard Ratio [HR]  = 0.33, 95%CI 0.17–0.65 and HR  = 0.30, 95%CI 0.17–0.51, respectively). The interaction term between ITN use and older age was HR  = 2.91, 95%CI 1.02–8.3, p = 0.045, indicating that ITNs did not protect older children. When multiple episodes were included in analysis, ITN use and older age were again protective against malaria episodes (Incident Rate Ratio [IRR]  = 0.43 95%CI 0.27–0.7) and IRR  = 0.23, 95%CI 0.13–0.42, respectively) and the interaction term indicated that ITNs did not protect older children (IRR  = 2.71, 95%CI 1.3–5.7, p = 0.008). CONCLUSIONS/SIGNIFICANCE: These data on age interactions with ITN use suggest that larger scale studies on the long term individual outcomes should be undertaken if the policy of targeted ITN use for vulnerable groups is to continue.
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spelling pubmed-27927232009-12-24 Interactions between Age and ITN Use Determine the Risk of Febrile Malaria in Children Bejon, Philip Ogada, Edna Peshu, Norbert Marsh, Kevin PLoS One Research Article BACKGROUND: Control measures which reduce individual exposure to malaria are expected to reduce disease, but also to eventually reduce immunity. Reassuringly, long term data following community wide ITN distribution show sustained benefits at a population level. However, the more common practice in Sub-Saharan Africa is to target ITN distribution on young children. There are few data on the long term outcomes of this practice. METHODOLOGY/PRINCIPAL FINDINGS: Episodes of febrile malaria were identified by active surveillance in 383 children over 18 months of follow up. In order to compare the short and long term outcomes of ITN use, we examined interactions between ITN use and age (12–42 months of age versus 42–80 months) in determining the risk of febrile malaria. ITN use and older age protected against the first or only episode of malaria (Hazard Ratio [HR]  = 0.33, 95%CI 0.17–0.65 and HR  = 0.30, 95%CI 0.17–0.51, respectively). The interaction term between ITN use and older age was HR  = 2.91, 95%CI 1.02–8.3, p = 0.045, indicating that ITNs did not protect older children. When multiple episodes were included in analysis, ITN use and older age were again protective against malaria episodes (Incident Rate Ratio [IRR]  = 0.43 95%CI 0.27–0.7) and IRR  = 0.23, 95%CI 0.13–0.42, respectively) and the interaction term indicated that ITNs did not protect older children (IRR  = 2.71, 95%CI 1.3–5.7, p = 0.008). CONCLUSIONS/SIGNIFICANCE: These data on age interactions with ITN use suggest that larger scale studies on the long term individual outcomes should be undertaken if the policy of targeted ITN use for vulnerable groups is to continue. Public Library of Science 2009-12-23 /pmc/articles/PMC2792723/ /pubmed/20037643 http://dx.doi.org/10.1371/journal.pone.0008321 Text en Bejon et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Bejon, Philip
Ogada, Edna
Peshu, Norbert
Marsh, Kevin
Interactions between Age and ITN Use Determine the Risk of Febrile Malaria in Children
title Interactions between Age and ITN Use Determine the Risk of Febrile Malaria in Children
title_full Interactions between Age and ITN Use Determine the Risk of Febrile Malaria in Children
title_fullStr Interactions between Age and ITN Use Determine the Risk of Febrile Malaria in Children
title_full_unstemmed Interactions between Age and ITN Use Determine the Risk of Febrile Malaria in Children
title_short Interactions between Age and ITN Use Determine the Risk of Febrile Malaria in Children
title_sort interactions between age and itn use determine the risk of febrile malaria in children
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792723/
https://www.ncbi.nlm.nih.gov/pubmed/20037643
http://dx.doi.org/10.1371/journal.pone.0008321
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