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We measured the two-week household-level economic impact of insecticide (permethrin)-treated bed nets (ITNs) used to prevent malaria among children less than five years of age in Asembo, Kenya. The ITNs induced a two-week reduction of 15 Kenyan shillings (KSH) (U.S. $0.25; P < 0.0001) in health care expenditures, but a statistically insignificant 0.5 day (P = 0.280) reduction in household time lost due to caring for sick children. The equivalent annual threshold cost was estimated at U.S. $6.50 (95% confidence interval = 3.12–9.86). If the actual purchase price and maintenance costs of ITNs were greater than this threshold, then households would pay more than they would save (and vice-versa). Both seasonal effects and number of children per household had larger impacts than ITNs on health care expenditures and time lost from household activities. Health care expenditures by a household without ITNs and one child were only 32 KSH per two weeks (U.S. $0.50; P = 0.002), leaving little opportunity for household-level, ITN-induced direct savings. The widespread adoption of the ITNs will therefore probably require a subsidy.
Acknowledgments: We thank the people of Asembo Bay, who so cheerfully and patiently helped us with our study. This paper is published with the permission of the Director of the Kenya Medical Research Institute.
Financial support: The bed net 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).
Acknowledgments: We thank the people of Asembo Bay who so cheerfully and patiently helped us with our study.
Financial support: The bed net project was funded by the United States Agency for International Development. Dianne J. Terlouw was supported by a grant from the Dutch Foundation for the Development of Tropical Research (WOTRO) (The Hague, The Netherlands).
Authors’ addresses: Martin I. Meltzer, Office of Surveillance, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop D-59, 1600 Clifton Road, Atlanta, GA 30333. Dianne J. Terlouw, Margarette S. Kolczak, Feiko O. ter Kuile, William A. Hawley, and Penelope A. Philips-Howard, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30333. Amos Odhacha, John M. Vulule, and Jane A. Alaii, 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.
Authors’ addresses: Martin I. Meltzer, Mailstop D-59, Office of Surveillance, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333. Dianne J. Terlouw, Margarette S. Kolczak, Feiko O. ter Kuile, William A. Hawley, and Penelope A. Phillips-Howard, Mailstop F-22, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341. Amos Odhacha, John M. Vulule, and Jane A. Alaii, 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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