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Information on the impact of insecticide (permethrin)-treated bed nets (ITNs) from randomized controlled trials in areas of intense perennial malaria transmission is limited. As part of a large-scale, community-based, group-randomized controlled trial of the effect of ITNs on childhood mortality in a holoendemic area in western Kenya, we conducted three cross-sectional surveys in 60 villages to assess the impact of ITNs on morbidity in 1,890 children less than three years old. Children in ITN and control villages were comparable pre-intervention, but after the introduction of ITNs, children in intervention villages were less likely to have recently experienced illness requiring treatment (protective efficacy [95% confidence intervals] = 15% [1–26%]), have an enlarged spleen (32% [20–43%]), be parasitemic (19% [11–27%]), have clinical malaria (44% [6–66%]), have moderately severe anemia (hemoglobin level < 7.0 g/dL; 39% [18–54%]), or have a pruritic body rash, presumably from reduced nuisance insect bites (38% [24–50%]). Use of ITNs was also associated with significantly higher mean weight-for-age Z-scores and mid-upper arm circumferences. There was no evidence, however, that ITNs reduced the risk of helminth infections, diarrhea, or upper or lower respiratory tract infections. The ITNs substantially reduced malaria-associated morbidity and improved weight gain in young children in this area of intense perennial malaria transmission.
Acknowledgments: We express our gratitude to the children and caregivers who participated in the study and the many people that assisted with this project. We thank John Paul Clark, Neen Alrutz, and Mary Ettling for their continued interest and support. We are grateful to Dr. Laurence Slutsker (Centers for Disease Control and Prevention) for reviewing this manuscript. We also thank the Director of the Kenya Medical Research Institute for his permission to publish this work.
Financial support: The ITN project was funded by the United States Agency for International Development. Feiko O. ter Kuile and Dianne J. Terlouw were supported in part by a grant from the Netherlands Foundation for the Advancement of Tropical Research (WOTRO) (The Hague, The Netherlands). Jennifer F. Friedman was supported by a United States Fulbright Award.
Disclaimer: The opinions or assertions contained in this manuscript are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Public Health Service or Department of Health and Human Services. Use of trade names is for identification only and does not imply endorsement by the U.S. Public Health Service or Department of Health and Human Services.
Authors’ addresses: Feiko O. ter Kuile, Dianne J. Terlouw, Penelope A. Phillips-Howard, William A. Hawley, and Margarette S. Kolczak, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. Jennifer F. Friedman, International Health Institute, Brown University, Box G-B 495, Providence, RI 02912. Simon K. Kariuki, Ya Ping Shi, and John M. Vulule, Centre for Vector Biology and Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. Arthur W. Kwena, Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
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