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Am. J. Trop. Med. Hyg., 68(4 suppl), 2003, pp. 121-127
Copyright © 2003 by The American Society of Tropical Medicine and Hygiene

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COMMUNITY-WIDE EFFECTS OF PERMETHRIN-TREATED BED NETS ON CHILD MORTALITY AND MALARIA MORBIDITY IN WESTERN KENYA

WILLIAM A. HAWLEY, PENELOPE A. PHILLIPS-HOWARD, FEIKO O. TER KUILE, DIANNE J. TERLOUW, JOHN M. VULULE, MAURICE OMBOK, BERNARD L. NAHLEN, JOHN E. GIMNIG, SIMON K. KARIUKI, MARGARETTE S. KOLCZAK, AND ALLEN W. HIGHTOWER
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Spatial analyses of the effect of insecticide (permethrin)-treated bed nets (ITNs) on nearby households both with and without ITNs was performed in the context of a large-scale, group-randomized, controlled mortality trial in Asembo, western Kenya. Results illustrate a protective effect of ITNs on compounds lacking ITNs located within 300 meters of compounds with ITNs for child mortality, moderate anemia, high-density parasitemia, and hemoglobin levels. This community effect on nearby compounds without nets is approximately as strong as the effect observed within villages with ITNs. This implies that in areas with intense malaria transmission with high ITN coverage, the primary effect of insecticide-treated nets is via area-wide effects on the mosquito population and not, as commonly supposed, by simple imposition of a physical barrier protecting individuals from biting. The strength of the community effect depended upon the proportion of nearby compounds with treated nets. To maximize their public health impact, high coverage with treated nets is essential.

Acknowledgments: The authors thank the residents of Asembo for their participation in this study. Many people assisted with field activities and data management; special thanks are due to George Olang and Erik Schoute for their assistance. We also thank all of those at the Centers for Disease Control and Prevention (Atlanta, GA) who supported our efforts to apply GPS mapping technology and spatial analytic techniques to the ITN project. This paper is published with the permission of the Director of the Kenya Medical Research Institute.

Financial support: The ITN project was funded by the United States Agency for International Development.

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: William A. Hawley, Penelope A. Phillips-Howard, Feiko O. ter Kuile, Dianne J. Terlouw, John E. Gimnig, Margarette S. Kolczak, and Allen W. Hightower, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. John M. Vulule, Maurice Ombok, and Simon K. Kariuki, Centre for Vector Biology and Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.




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