***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : To assess the impact of a social marketing programme for distributing nets treated with insecticide on malarial parasitaemia and anaemia in very young children in an area of high malaria transmission . Design : Community cross sectional study . Annual , cross sectional data were collected at the beginning of the social marketing campaign ( 1997 ) and the subsequent two years . Net ownership and other risk and confounding factors were assessed with a question naire . Blood sample s were taken from the children to assess prevalence of parasitaemia and haemoglobin levels . Setting : 18 villages in the Kilombero and Ulanga districts of southwestern Tanzania . Participants : A r and om sample of children aged under 2 years . Main outcome measures : The presence of any parasitaemia in the peripheral blood sample and the presence of anaemia ( classified as a haemoglobin level of ≤80 g/l ) . Results : Ownership of nets increased rapidly ( treated or not treated nets : from 58 % to 83 % ; treated nets : from 10 % to 61 % ) . The mean haemoglobin level rose from 80 g/l to 89 g/l in the study children in the successive surveys . Overall , the prevalence of anaemia in the study population decreased from 49 % to 26 % in the two years studied . Treated nets had a protective efficacy of 62 % ( 95 % confidence interval 38 % to 77 % ) on the prevalence of parasitaemia and of 63 % ( 27 % to 82 % ) on anaemia . Conclusions : These results show that nets treated with insecticide have a substantial impact on morbidity when distributed in a public health setting Background Insecticide-treated bed nets ( ITNs ) have been shown to reduce morbidity and mortality due to malaria in sub-Saharan Africa . Strategies using incentives to increase ITN use could be more efficient than traditional distribution campaigns . To date , behavioural incentives have been studied mostly in developed countries . No study has yet looked at the effect of incentives on the use of ITNs . Reported here are the results of a cluster r and omized controlled trial testing household-level incentives for ITN use following a free ITN distribution campaign in Madagascar . Methods The study took place from July 2007 until February 2008 . Twenty-one villages were r and omized to either intervention or control clusters . Households in both clusters received a coupon redeemable for one ITN . After one month , intervention households received a bonus for ITN use , determined by visual confirmation of a mounted ITN . Data were collected at baseline , one month and six months . Both unadjusted and adjusted results , using cluster specific methods , are presented . Results At baseline , 8.5 % of households owned an ITN and 6 % were observed to have a net mounted over a bed in the household . At one month , there were no differences in ownership between the intervention and control groups ( 99.5 % vs. 99.4 % ) , but net use was substantially higher in the intervention group ( 99 % vs. 78 % ) , with an adjusted risk ratio of 1.24 ( 95 % CI : 1.10 to 1.40 ; p < 0.001 ) . After six months , net ownership had decreased in the intervention compared to the control group ( 96.7 % vs. 99.7 % ) , with an adjusted risk ratio of 0.97 ( p < 0.01 ) . There was no difference between the groups in terms of ITN use at six months ; however , intervention households were more likely to use a net that they owned ( 96 % vs. 90 % ; p < 0.001 ) . Conclusions Household-level incentives have the potential to significantly increase the use of ITNs in target households in the immediate-term , but , over time , the use of ITNs is similar to households that did not receive incentives . Providing incentives for behaviour change is a promising tool that can complement traditional ITN distribution programmes and improve the effectiveness of ITN programmes in protecting vulnerable population s , especially in the short-term OBJECTIVE To estimate the effectiveness , costs and cost-effectiveness of providing long-lasting insecticide-treated nets ( LLINs ) and point-of-use water filters to  antiretroviral therapy (ART)-naïve HIV-infected adults and their family members , in the context of a multisite study in Kenya of 589 HIV-positive adults followed on average for 1.7 years . METHODS The effectiveness , costs and cost-effectiveness of the intervention were estimated using an epidemiologic-cost model . Model epidemiologic inputs were derived from the Kenya multisite study data , local epidemiological data and from the published literature . Model cost inputs were derived from published literature specific to Kenya . Uncertainty in the model estimates was assessed through univariate and multivariate sensitivity analyses . RESULTS We estimated net cost savings of about US$ 26 000 for the intervention , over 1.7 years . Even when ignoring net cost savings , the intervention was found to be very cost-effective at a cost of US$ 3100 per death averted or US$ 99 per disability-adjusted life year ( DALY ) averted . The findings were robust to the sensitivity analysis and remained most sensitive to both the duration of ART use and the cost of ART per person-year . CONCLUSIONS The provision of LLINs and water filters to ART-naïve HIV-infected adults in the Kenyan study result ed in substantial net cost savings , due to the delay in the initiation of ART . The addition of an LLIN and a point-of-use water filter to the existing package of care provided to ART-naïve HIV-infected adults could bring substantial cost savings to re source -constrained health systems in low- and middle-income countries BACKGROUND Home management of malaria-the presumptive treatment of febrile children with antimalarial drugs-is advocated to ensure prompt effective treatment of the disease . We assessed the effect of home delivery of artemether-lumefantrine on the incidence of antimalarial treatment and on clinical outcomes in children from an urban setting with fairly low malaria transmission . METHODS In Kampala , Ug and a , 437 children aged between 1 and 6 years from 325 households were r and omly assigned by a computer-generated sequence to receive home delivery of prepackaged artemether-lumefantrine for presumptive treatment of febrile illnesses ( n=225 ) or current st and ard of care ( n=212 ) . R and omisation was done by household after a pilot period of 1 month . After r and omisation , study participants were followed up for an additional 12 months and information on their health and treatment of illnesses was obtained by use of monthly question naires and household diaries , which were completed by the participants ' carers . The primary outcome was treatment incidence density per person-year . Analysis of the primary outcome was done on the modified intention-to-treat population , which included all participants apart from those excluded before data collection . This trial is registered with Clinical Trials.gov , number NCT00115921 . FINDINGS Eight participants in the home management group and four in the st and ard care group were excluded before data collection ; therefore , the primary analysis was done in 217 and 208 participants , respectively . The home management group received nearly twice the number of antimalarial treatments as the st and ard care group ( 4.66 per person-year vs 2.53 per person-year ; incidence rate ratio [ IRR ] 1.72 , 95 % CI 1.43 - 2.06 , p<0.0001 ) , and nearly five times the number given to children with microscopically confirmed malaria in a comparable cohort of children ( 4.66 per person-year vs 1.03 per person-year , IRR 5.19 , 95 % CI 4.24 - 6.35 , p<0.0001 ) . Clinical data were available for 189 children in the home management group and 176 in the control group at study end ; the main reasons for exclusion were movement out of the study area or loss to follow-up . The proportion of participants with parasitaemia at final assessment in the intervention group was lower than in the control group ( four [ 2 % ] vs 17 [ 10 % ] , p=0.006 ) , but there were no other differences in st and ard malariometric indices , including anaemia . Serious adverse events were captured retrospectively . One child died in each group ( home management-severe pneumonia and possible septicaemia ; st and ard care-presumed respiratory failure ) . INTERPRETATION Although home management of malaria led to prompt treatment of fever , there was little effect on clinical outcomes . The substantial over-treatment suggests that artemether-lumefantrine provided in the home might not be appropriate for large urban areas or setting s with fairly low malaria transmission . FUNDING Gates Malaria Partnership Background Insecticide-treated nets ( ITNs ) reduce malaria morbidity and mortality , but use is limited . A barrier to ITN use may be lack of knowledge regarding malaria transmission and prevention . This study is a controlled trial comparing ITN use and malaria knowledge levels between households in Piron , Mali , undertaken in 2003 . Methods Households  received net impregnation services either with or without antecedent education . The main outcome measure was ITN use , defined as impregnation of at least one of the household 's existing bednets with insecticide during the study . Knowledge about malaria and prevention practice s was assessed pre- and post- educational intervention . Results were analysed by household and by individual . Results Forty-nine percent ( 34/70 ) of households who received the educational component impregnated their nets in comparison to 35 % ( 22/62 ) of households who did not ( OR = 1.6 CI = 0.8–3.3 , P = 0.19 ) . In individual analysis , ITN use was significantly greater in participants who had received the educational intervention ( 48 % ) vs. individuals who did not ( 33 % , OR = 1.9 , P = 0.012 ) . Knowledge levels about malaria significantly increased for each individual pre- versus post- educational intervention ( average change score = 2.13 , st and ard deviation = 1.97 , t = -17.78 , P < 0.001 ) , although there was no difference found between educational ( change score = 2.14 ) and control groups ( change score = 2.12 ) . Conclusion It is possible to educate individuals about malaria and to implement net impregnation services with limited re sources . Greater accessibility to net-impregnation services is necessary but not sufficient to increase ITN use Spatial analyses of the effect of insecticide (permethrin)-treated bed nets ( ITNs ) on nearby households both with and without ITNs was performed in the context of a large-scale , group-r and omized , controlled mortality trial in Asembo , western Kenya . Results illustrate a protective effect of ITNs on compounds lacking ITNs located within 300 meters of compounds with ITNs for child mortality , moderate anemia , high-density parasitemia , and hemoglobin levels . This community effect on nearby compounds without nets is approximately as strong as the effect observed within villages with ITNs . This implies that in areas with intense malaria transmission with high ITN coverage , the primary effect of insecticide-treated nets is via area-wide effects on the mosquito population and not , as commonly supposed , by simple imposition of a physical barrier protecting individuals from biting . The strength of the community effect depended upon the proportion of nearby compounds with treated nets . To maximize their public health impact , high coverage with treated nets is essential Background Intermittent preventive treatment for malaria in children ( IPTc ) is a promising new intervention for the prevention of malaria but its delivery is a challenge . We have evaluated the coverage of IPTc that can be achieved by two different delivery systems in Ghana . Methods IPTc was delivered by volunteers in six villages ( community-based arm ) and by health workers at health centres or at Exp and ed Programme on Immunisation outreach clinics ( facility based ) in another six communities . The villages were selected r and omly and drugs were administered in May , June , September and October 2006 . The first dose of a three-dose regimen of amodiaquine plus sulphadoxine-pyrimethamine was administered under supervision to 3–59 month-old children ( n = 964 ) in the 12 study villages ; doses for days 2 and 3 were given to parents/guardians to administer at home . Results The proportion of children who received at least the first dose of 3 or more courses of IPTc  was slightly higher in the community based arm ( 90.5 % vs 86.6 % ; p = 0.059 ) . Completion of the three dose regimen was high and similar with both delivery systems ( 91.6 % and 91.7 % respectively ) . Conclusion Seasonal IPTc delivered through community-based or facility-based systems can achieve a high coverage rate with the support and supervision of the district health management team . However , in order to maximise the impact of IPTc , both delivery systems may be needed in some setting s. Trial Registration Clinical Trials.gov BACKGROUND Clinical malaria and severe anaemia are major causes of paediatric hospital admission and death in many malaria-endemic setting s. In the absence of an effective and affordable vaccine , control programmes continue to rely on case management while attempting the large-scale deployment of insecticide-treated nets . We did a r and omised , placebo-controlled trial to assess the efficacy and safety of intermittent sulphadoxine-pyrimethamine treatment on the rate of malaria and severe anaemia in infants in a rural area of Tanzania . METHODS We r and omly assigned 701 children living in Ifakara , southern Tanzania 
    Output:
    
The subgroup analysis suggested that community-based distribution of ITNs , impregnated bed sheets and IRS , and IPT are effective strategies .
Qualitative synthesis suggests that high coverage could be achieved at a lower cost with the integration of CBIs with existing antenatal care and immunization campaigns .