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Why bednet programs result in inaccurate measures of malaria transmission

January 1, 2013 - 21:49 -- William Jobin

Epidemiological Nugget Number One: Bednets are avoided by adults, especially during the hot and humid malaria season.......However infants cannot escape their mothers protective care, thus infants usually sleep under bednets, even though no one else in the family does.........Now - what happens when groups like PMI report their success in terms of reduced Infant Mortality, or prevalence of malaria among infants?..........It is no surprise that Infant Mortality drops because the infants are sleeping under bednets. But that does not also mean that transmission is interrupted or that overall Malaria Mortality drops. Instead the infections and mortality are just delayed - to hit older children, as they learn to escape the uncomfortable bednets.........Conclusion - you have to measure transmission by careful random sampling in the total population.......... PMI beware.