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Impact of mass distribution of free long-lasting insecticidal nets on childhood malaria morbidity: The Togo National Integrated Child Health Campaign

Terlouw, Anja ORCID:, Morgah, Kodjo, Wolkon, Adam, Dare, Aboudou, Dorkenoo, Ameyo, Eliades, M James, Vanden Eng, Jodi, Sodahlon, Yao K, terKuile, Feiko ORCID: and Hawley, William A. (2010) 'Impact of mass distribution of free long-lasting insecticidal nets on childhood malaria morbidity: The Togo National Integrated Child Health Campaign'. Malaria Journal, Vol 9, Issue 199.

TERLOUW_DJ_2010_Malaria_Journal_Impact_of_Mass__.pdf - Published Version

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Background: An evaluation of the short-term impact on childhood malaria morbidity of mass distribution of free
long-lasting insecticidal nets (LLINs) to households with children aged 9-59 months as part of the Togo National
Integrated Child Health Campaign.
Methods: The prevalence of anaemia and malaria in children aged zero to 59 months was measured during two
cross-sectional household cluster-sample surveys conducted during the peak malaria transmission, three months
before (Sept 2004, n = 2521) and nine months after the campaign (Sept 2005, n = 2813) in three districts
representative of Togo’s three epidemiological malaria transmission regions: southern tropical coastal plains (Yoto),
central fertile highlands (Ogou) and northern semi-arid savannah (Tone).
Results: In households with children <5 years of age, insecticide-treated net (ITN) ownership increased from <1%
to >65% in all 3 districts. Reported ITN use by children during the previous night was 35.9%, 43.8% and 80.6% in
Yoto, Ogou and Tone, respectively. Rainfall patterns were comparable in both years. The overall prevalence of
moderate to severe anaemia (Hb < 8.0 g/dL) was reduced by 28% (prevalence ratio [PR] 0.72, 95% CI 0.62-0.84) and
mean haemoglobin was increased by 0.35 g/dL (95% CI 0.25-0.45).
The effect was predominantly seen in children aged 18-59 months and in the two southern districts: PR (95% CI)
for moderate to severe anaemia and clinical malaria: Yoto 0.62 (0.44-0.88) and 0.49 (0.35-0.75); Ogou 0.54 (0.37-0.79)
and 0.85 (0.57-1.27), respectively. Similar reductions occurred in children <18 months in Ogou, but not in Yoto. No
effect was seen in the semi-arid northern district despite a high malaria burden and ITN coverage.
Conclusions: A marked reduction in childhood malaria associated morbidity was observed in the year following
mass distribution of free LLINs in two of the three districts in Togo. Sub-national level impact evaluations will
contribute to a better understanding of the impact of expanding national malaria control efforts.

Item Type: Article
Additional Information: The electronic version of this article is the complete one and can be found online at:
Uncontrolled Keywords: Insecticide nets; malaria; anaemia; children
Subjects: WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WS Pediatrics > By Age Groups > WS 430 Infancy
WS Pediatrics > By Age Groups > WS 440 Preschool child
Digital Object Identifer (DOI):
Depositing User: Helen Wong
Date Deposited: 16 Aug 2010 10:23
Last Modified: 24 Jan 2022 15:39


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