Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Insecticide-treated bednets and curtains (ITBC) have proven in recent large-scale trials to have a high efficacy in reducing morbidity and mortality from malaria in African children. However, it is unlikely that the efficacy measured in trials can be entirely sustained under programme conditions. This has important implications for the cost-effectiveness of the intervention. Furthermore, there is a need to assess the long-term impact of ITBC. This article traces the history of ITBC and the different phases of their assessment, especially the determination of efficacy in randomized controlled trials (phase III assessment). It then outlines the reasons for continued assessment of their effectiveness under programme conditions (phase IV assessment). The methodologies for measuring effectiveness are discussed, and a critical review of the issues reveals that it is impractical to measure effectiveness directly. A simple effectiveness model, allowing for differentiation between individual and community effectiveness, provides a useful conceptual framework. First, individual effectiveness is measured through a case-control study. This estimate is then combined with a coverage indicator to estimate community effectiveness. This approach could provide programme managers with a powerful tool to monitor the impact of health interventions at the community level.

Type

Journal

Bulletin of the World Health Organization

Publication Date

01/1996

Volume

74

Pages

325 - 332

Addresses

Tropical Health and Epidemiology Unit, London School of Hygiene and Tropical Medicine, England.

Keywords

Humans, Malaria, Insecticides, Case-Control Studies, Program Evaluation, Bedding and Linens, Mosquito Control, Child, Cost-Benefit Analysis, Africa, Randomized Controlled Trials as Topic