Plaidoyer pour les moustiquaires imprégnées dans les programmes de lutte contre le paludisme

Abstract

Insecticide Treated Nets (ITNs) represent for Malaria Control Programmes an important and efficacious tool for decreasing malaria incidence. In a large number of countries outside Africa, where in most cases malaria is unstable or the risk of epidemics is high, the long-term efficacy of ITNs is widely accepted. However, it is unclear whether this applies to situations where transmission is intermediate or intense. Comparisons of epidemiological data from areas with different transmission levels led to contradictory results in terms of the long-term impact of ITNs in Africa. Besides the methodological problems, these comparisons do not take into account the mortality indirectly linked to malaria and the time distribution of infective bites. This discussion helps in drawing attention to the possible risk of shifting mortality and morbidity to older age groups. Although an increased incidence of cerebral malaria cannot be ruled out in areas of intense transmission, the overall impact will probably be beneficial. These non-conclusive comparisons should not slow down the implementation of ITN programmes. The first report on the long-term effect of ITNs contradicts the more pessimistic predictions. Simply reducing the transmission peaks could substantially decrease malaria mortality and morbidity The improvement of the distribution and re-impregnation systems should make ITNs more operational.