{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:10:47Z","timestamp":1789827047339,"version":"4.0.1"},"posted":{"date-parts":[[2026,9,16]]},"group-title":"Epidemiology","reference-count":26,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>Recent research highlights threats to the effectiveness of insecticide-treated bed nets (ITNs) against malaria transmission. This cross-sectional study (N=2819) investigated associations between bed net usage and malaria rapid diagnostic test (RDT) positivity among those presenting with malaria symptoms in three provinces of the Democratic Republic of the Congo (DRC). A log-binomial regression model was used to determine RDT-confirmed malaria prevalence ratios; prior malaria diagnosis and location of care were assessed as modifiers. Using a bed net the prior night was associated with lower risk of malaria diagnosis [PR of 1.39 (95% CI: 1.20, 1.62), with a quantitative bias analysis adjusted result of PR = 1.64]. ITN use reduced risk of malaria diagnoses regardless of prior malaria infection. However, prior diagnosis did modify the relationship between bed net usage and malaria RDT positivity, with prior diagnosis reducing bed net effectiveness. These findings add to existing literature showing the benefits of ITN use in highly malaria-endemic settings like the DRC.<\/jats:p>","DOI":"10.64898\/2026.09.15.26363108","type":"posted-content","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:37:10Z","timestamp":1789609030000},"source":"Crossref","is-referenced-by-count":0,"title":["Protective association between recent insecticide-treated bed net use and falciparum malaria in three provinces of the Democratic Republic of the Congo"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4531-8421","authenticated-orcid":false,"given":"Danielle L.","family":"Wiener","sequence":"first","affiliation":[{"name":"Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eddy","family":"Kieto","sequence":"additional","affiliation":[{"name":"University of Montreal, Montreal, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melchior M.","family":"Kashamuka","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Kinshasa, Kinshasa, DRC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2046-5836","authenticated-orcid":false,"given":"Mvuama","family":"Nono","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Kinshasa, Kinshasa, DRC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Juliano","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA"},{"name":"Division of Infectious Diseases, Department of Medicine, and Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernandine","family":"Phanzu","sequence":"additional","affiliation":[{"name":"SANRU Asbl, Kinshasa, Democratic Republic of the Congo (DRC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"N\u2019Siala","sequence":"additional","affiliation":[{"name":"SANRU Asbl, Kinshasa, Democratic Republic of the Congo (DRC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommy","family":"Nseka","sequence":"additional","affiliation":[{"name":"Programme Nationale de Lutte contre le Paludisme, Kinshasa, DRC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoinette K.","family":"Tshefu","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Kinshasa, Kinshasa, DRC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Kalonji","sequence":"additional","affiliation":[{"name":"SANRU Asbl, Kinshasa, Democratic Republic of the Congo (DRC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Sheahan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris","family":"Likwela","sequence":"additional","affiliation":[{"name":"SANRU Asbl, Kinshasa, Democratic Republic of the Congo (DRC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4465-9830","authenticated-orcid":false,"given":"Jonathan B.","family":"Parr","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, and Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026091906500758000_2026.09.15.26363108v1.1","unstructured":"World Health Organization. World malaria report 2023. Geneva: World Health Organization; 2023. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789240086173. Accessed 2024 Jan 5."},{"key":"2026091906500758000_2026.09.15.26363108v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(21)00216-3"},{"issue":"4","key":"2026091906500758000_2026.09.15.26363108v1.3","first-page":"564","article-title":"Uso di zanzariere trattata con insetticida nell\u2019Africa Sub-Sahariana: rivista sistematica e meta-analisi [Insecticide-treated net use in Sub-Saharan Africa: systematic review and meta-analysis]","volume":"78","year":"2021","journal-title":"Ig Sanita Pubbl"},{"key":"2026091906500758000_2026.09.15.26363108v1.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-002316"},{"key":"2026091906500758000_2026.09.15.26363108v1.5","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-023-04655-7"},{"key":"2026091906500758000_2026.09.15.26363108v1.6","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-9-279"},{"key":"2026091906500758000_2026.09.15.26363108v1.7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0053755"},{"key":"2026091906500758000_2026.09.15.26363108v1.8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0289469"},{"key":"2026091906500758000_2026.09.15.26363108v1.9","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012776.pub3"},{"key":"2026091906500758000_2026.09.15.26363108v1.10","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-018-2183-y"},{"key":"2026091906500758000_2026.09.15.26363108v1.11","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15030546"},{"key":"2026091906500758000_2026.09.15.26363108v1.12","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(18)30172-5"},{"key":"2026091906500758000_2026.09.15.26363108v1.13","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000363.pub3"},{"key":"2026091906500758000_2026.09.15.26363108v1.14","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jix570"},{"key":"2026091906500758000_2026.09.15.26363108v1.15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2008.02179.x"},{"key":"2026091906500758000_2026.09.15.26363108v1.16","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-85913-z"},{"key":"2026091906500758000_2026.09.15.26363108v1.17","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-018-2371-9"},{"key":"2026091906500758000_2026.09.15.26363108v1.18","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-9-192"},{"key":"2026091906500758000_2026.09.15.26363108v1.19","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-87959-8"},{"key":"2026091906500758000_2026.09.15.26363108v1.20","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-018-2197-5"},{"key":"2026091906500758000_2026.09.15.26363108v1.21","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-1497-0"},{"key":"2026091906500758000_2026.09.15.26363108v1.22","doi-asserted-by":"crossref","unstructured":"Ansoms A , Claessens K . Land relations and local livelihoods in the Great Lakes Region. In: Ansoms A , Marysse S , editors. Natural resources and local livelihoods in the Great Lakes Region of Africa: a political economy perspective. London: Palgrave Macmillan; 2011. p. 3\u201325.","DOI":"10.1057\/9780230304994_1"},{"key":"2026091906500758000_2026.09.15.26363108v1.23","doi-asserted-by":"crossref","unstructured":"Mukenge T. Culture and customs of the Congo. Westport (CT): Greenwood Press; 2002.","DOI":"10.5040\/9798400635922"},{"key":"2026091906500758000_2026.09.15.26363108v1.24","unstructured":"Hochschild A. King Leopold\u2019s ghost: a story of greed, terror, and heroism in colonial Africa. Boston: Mariner Books; 1999."},{"key":"2026091906500758000_2026.09.15.26363108v1.25","doi-asserted-by":"crossref","unstructured":"Gondola CD . The history of Congo. Westport (CT): Greenwood Press; 2002.","DOI":"10.5040\/9798400664632"},{"key":"2026091906500758000_2026.09.15.26363108v1.26","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-020-03286-6"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.09.15.26363108","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T13:50:17Z","timestamp":1789825817000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.09.15.26363108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":26,"URL":"https:\/\/doi.org\/10.64898\/2026.09.15.26363108","relation":{},"subject":[],"published":{"date-parts":[[2026,9,16]]},"subtype":"preprint"}}