Discussion
malaria, adverse drug reactions
ADVERSE EVENTS, ADVERSE DRUG REACTIONS, MALARIA
This study showed that approximately 1 in 5 children had an AE within 24 h following LLINs use. This result was consistent with studies done in Mali demonstrating adverse events after using the LLINs [Sleeping under deltamethrin LLINs was associated with a five-fold higher risk of experiencing AEs after the mass distribution of LLINs. However, residual confounding factors may partly explain these findings. Deltamethrin LLINs may be less effective at preventing malaria than deltamethrin + PBO. As such, the higher proportion of AEs observed in children sleeping under deltamethrin LLINs may be due to untreated malaria. Several factors could explain this difference in the occurrence of adverse events, including the quality of mosquito nets. In this study, some nets had an incorrect residual dosage, either above or below the manufacturer's declared threshold. Although this study was descriptive and was not designed to compare the risk of reporting adverse events between the two types of mosquito nets, these results warrant further consideration in future studies. Zinc roofing was associated with almost a two-fold higher risk of AEs. These results were unexpected but may warrant further consideration in future studies.The present study has several strengths. First, this is the first community-based cross-sectional study to determine the prevalence and predictors of AEs after exposure to LLINs in the DRC. Second, this is the first study that captures AEs following exposure to LLINs using active pharmacovigilance surveillance. Third, findings from this study will help design and implement knowledge-based intervention to reduce AEs and improve compliance to malaria prevention strategies in the DRC. Finally, these findings provide hypothesis-generating research to be tested in future studies using robust design. For example, future research should compare the two LLINs safety to determine which option is associated with fewer AEs.This study has several limitations. First, misclassification of the outcome in this study cannot be ruled out since the AEs were subjectively assessed in a recent survey after the occurrence of the outcome. Second, underreporting is a concern inherent to pharmacovigilance studies. For example, several studies have suggested that less than 10% of detected adverse drug reactions are effectively reported to medicine regulatory authorities [