Researchers tested the hypothesis that the acquisition of functional immunity might delay and child deaths might shift from younger to older ages because of malaria control in early childhood (< 5 years of age) in high-transmission settings.

• The correlation between early-life use of treated nets and survival to adulthood was assessed using data retrieved from a 22-year prospective cohort study in rural southern Tanzania.

• Enrollment of a total of 6,706 children was done.

• Information on the vital status of 5,983 participants (89%) was verified in 2019.

• As per the reports of early-life community outreach visits, a treated net was never used for sleeping by nearly one quarter of children, a treated net was used some of the time by one half of children, and the remaining quarter always slept under a treated net.

• Persistence of the survival benefit from early-life use of treated nets was observed to adulthood in this long-term study of early-life malaria control in a high-transmission setting.