The degree of effectiveness of mosquito nets against malaria in the Americas has remained uncertain. We carried out a case-control study of net use and mild malaria in the Amazonas state of Colombia. Two hundred ninety cases were enrolled via the Health Department services, and 977 community-based controls matched for age, sex, and place of residence. We found that a large proportion of the population (96% of controls) slept under nets. Nevertheless, we found a benefit of impregnated nets compared with no net use: adjusted odds ratio (OR) for mild malaria 0.44, 95% confidence interval (CI) 0.20-0.98. Nonimpregnated nets had a benefit that was only slightly smaller but not statistically significant (OR for mild malaria 0.54, 95% CI 0.25-1.18). Travel in the previous month had an odds ratio of 6.2 (95% CI 3.1-8.8) and a population attributable fraction of 13% compared with 11% for failure to use an impregnated net. We conclude that, in the Amazon region, promotion of mosquito net use and impregnation is justified, and that there is a need for measures to protect travelers from malaria.

The recombinant Cuban hepatitis B vaccine has contributed to the reduction of the infection in this highly endemic area, though further efforts are required to improve timely vaccination for children at high risk.

To provide information for public health policy on mosquito nets in the Amazon region of Colombia, we conducted landing catches to estimate Anopheles species composition and biting activity. Two hundred twenty person-nights of catches were done in seven locations over a period of 14 mo. A total of 1,780 Anopheles mosquitoes were caught (8.1 per person-night). Among the nine species found, An. oswaldoi Peryassú was the most common (776 mosquitoes, 44%), followed by An. darlingi Root s.l. (498, 28%). An. oswaldoi was the most common species collected outdoors, where its biting rate dropped steadily from a peak of >15 bites/person-night at the start of the night (1800-1900 hours) to approximately equal to 2 bites/person-night before dawn. An. darlingi was the most common species collected indoors, with a biting rate of approximately equal to 3-4 bites/person-night until about midnight, when the rate dropped below 1 bite/person-night, before showing a secondary peak before dawn. Sixty-four mosquito nets were analyzed by the technique of high-performance liquid chromatography (HPLC) for levels of deltamethrin (DM). All but two (62) of these were reported by their owners to have been impregnated with insecticide, and 53 were found by HPLC to have deltamethrin. However, one half (32) of the nets had concentrations <4 mg/m2 and therefore were likely to have been inadequately protective. An inverse association was found between the reported time between washes and deltamethrin concentration. These findings show a need for additional protection from mosquitoes when not inside nets, as well as for more effective impregnation, possibly through wash-resistant insecticide formulation.

The HB control program in Colombia has achieved good coverage in one of the most endemic areas of the country. However, barriers to vaccination arise from inequities in the distribution of health insurance and inadequate HW knowledge.

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