HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (13) Citing Articles via Google Scholar Google Scholar Articles by PHILLIPS-HOWARD, P. A. Articles by HAWLEY, W. A. Search for Related Content PubMed PubMed Citation Articles by PHILLIPS-HOWARD, P. A. Articles by HAWLEY, W. A. Related Collections Epidemiology Helicobacter Malaria Medical Entomology

IMPACT OF PERMETHRIN-TREATED BED NETS ON THE INCIDENCE OF SICK CHILD VISITS TO PERIPHERAL HEALTH FACILITIES

During a randomized controlled trial of insecticide (permethrin)-treated bed nets (ITNs) in an area with intense malaria transmission in western Kenya, we monitored 20,915 sick child visits (SCVs) by children less than five years of age visiting seven peripheral health facilities. The SCVs were monitored over a four-year period both before (1995–1996) and during the intervention (1997–1998). Results are used to estimate the effect of ITNs on the burden of malaria in this community and to evaluate the potential role of these facilities in assessment of the impact of large-scale public health interventions. Compared with baseline, a 27% greater reduction in the incidence of SCVs was seen in ITN villages than in control villages (37% versus 10%; P = 0.049). A similar reduction was observed in SCVs diagnosed as malaria (35% reduction in ITN villages versus 5% reduction in controls; P = 0.04). Two-hundred sixteen SCVs per 1,000 child-years were prevented; three-fourths of these were in children less than 24 months old. As a consequence of lack of laboratory facilities, severe anemia was rarely (< 2%) diagnosed, regardless of intervention status. No effect of ITNs on the incidence of respiratory tract infections, diarrhea, and other commonly diagnosed childhood illnesses was observed. The ITNs reduced the number of SCVs due to malaria, but had no effect on other illnesses. Routine statistics from these facilities provided useful information on trends in malaria incidence, but underestimated the burden of severe anemia.

Acknowledgments: We thank the health facility recorders and data entry staff for their contribution to this study, and Caleb Ouma and Gideon Ogude for their supervisory assistance. We are grateful to the residents of Asembo for their cooperation. Dr. Kevin DeCock is thanked for his comments on the manuscript. Kathleen A. Wannemuehler acknowledges administrative support from the Oak Ridge Institute for Science and Education (Oak Ridge, TN). 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.

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: Penelope A. Phillips-Howard, Kathleen A. Wannemuehler, Margarette S. Kolczak, Feiko O. ter Kuile, John E. Gimnig, Kris Olson, and William A. Hawley, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland. Jane A. Alaii, Amos Odhacha, and John M. Vulule, Centre for Vector Biology and Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya.

This article has been cited by other articles:

				P. E. OKELLO, W. VAN BORTEL, A. M. BYARUHANGA, A. CORREWYN, P. ROELANTS, A. TALISUNA, U. D'ALESSANDRO, and M. COOSEMANS Variation in malaria transmission intensity in seven sites throughout Uganda. Am J Trop Med Hyg, August 1, 2006; 75(2): 219 - 225. [Abstract] [Full Text] [PDF]

				K. ADAZU, K. A. LINDBLADE, D. H. ROSEN, F. ODHIAMBO, P. OFWARE, J. KWACH, A. M. VAN EIJK, K. M. DECOCK, P. AMORNKUL, D. KARANJA, et al. HEALTH AND DEMOGRAPHIC SURVEILLANCE IN RURAL WESTERN KENYA: A PLATFORM FOR EVALUATING INTERVENTIONS TO REDUCE MORBIDITY AND MORTALITY FROM INFECTIOUS DISEASES Am J Trop Med Hyg, December 1, 2005; 73(6): 1151 - 1158. [Abstract] [Full Text] [PDF]

				P. A. PHILLIPS-HOWARD, F. O. TER KUILE, B. L. NAHLEN, J. A. ALAII, J. E. GIMNIG, M. S. KOLCZAK, D. J. TERLOUW, S. K. KARIUKI, Y. P. SHI, S. P. KACHUR, et al. THE EFFICACY OF PERMETHRIN-TREATED BED NETS ON CHILD MORTALITY AND MORBIDITY IN WESTERN KENYA II. STUDY DESIGN AND METHODS Am J Trop Med Hyg, April 1, 2003; 68(90040): 10 - 15. [Abstract] [Full Text] [PDF]

				P. A. PHILLIPS-HOWARD, B. L. NAHLEN, M. S. KOLCZAK, A. W. HIGHTOWER, F. O. TER KUILE, J. A. ALAII, J. E. GIMNIG, J. ARUDO, J. M. VULULE, A. ODHACHA, et al. EFFICACY OF PERMETHRIN-TREATED BED NETS IN THE PREVENTION OF MORTALITY IN YOUNG CHILDREN IN AN AREA OF HIGH PERENNIAL MALARIA TRANSMISSION IN WESTERN KENYA Am J Trop Med Hyg, April 1, 2003; 68(90040): 23 - 29. [Abstract] [Full Text] [PDF]

				J. ARUDO, J. E. GIMNIG, F. O. TER KUILE, S. P. KACHUR, L. SLUTSKER, M. S. KOLCZAK, W. A. HAWLEY, A. S. S. ORAGO, B. L. NAHLEN, and P. A. PHILLIPS-HOWARD COMPARISON OF GOVERNMENT STATISTICS AND DEMOGRAPHIC SURVEILLANCE TO MONITOR MORTALITY IN CHILDREN LESS THAN FIVE YEARS OLD IN RURAL WESTERN KENYA Am J Trop Med Hyg, April 1, 2003; 68(90040): 30 - 37. [Abstract] [Full Text] [PDF]

				P. A. PHILLIPS-HOWARD, K. A. WANNEMUEHLER, F. O. TER KUILE, W. A. HAWLEY, M. S. KOLCZAK, A. ODHACHA, J. M. VULULE, and B. L. NAHLEN DIAGNOSTIC AND PRESCRIBING PRACTICES IN PERIPHERAL HEALTH FACILITIES IN RURAL WESTERN KENYA Am J Trop Med Hyg, April 1, 2003; 68(90040): 44 - 49. [Abstract] [Full Text] [PDF]

				F. O. TER KUILE, D. J. TERLOUW, S. K. KARIUKI, P. A. PHILLIPS-HOWARD, L. B. MIREL, W. A. HAWLEY, J. F. FRIEDMAN, Y. P. SHI, M. S. KOLCZAK, A. A. LAL, et al. IMPACT OF PERMETHRIN-TREATED BED NETS ON MALARIA, ANEMIA, AND GROWTH IN INFANTS IN AN AREA OF INTENSE PERENNIAL MALARIA TRANSMISSION IN WESTERN KENYA Am J Trop Med Hyg, April 1, 2003; 68(90040): 68 - 77. [Abstract] [Full Text] [PDF]

				J. A. ALAII, H. W. VAN DEN BORNE, S. P. KACHUR, H. MWENESI, J. M. VULULE, W. A. HAWLEY, M. I. MELTZER, B. L. NAHLEN, and P. A. PHILLIPS-HOWARD PERCEPTIONS OF BED NETS AND MALARIA PREVENTION BEFORE AND AFTER A RANDOMIZED CONTROLLED TRIAL OF PERMETHRIN-TREATED BED NETS IN WESTERN KENYA Am J Trop Med Hyg, April 1, 2003; 68(90040): 142 - 148. [Abstract] [Full Text] [PDF]

				V. WISEMAN, W. A. HAWLEY, F. O. TER KUILE, P. A. PHILLIPS-HOWARD, J. M. VULULE, B. L. NAHLEN, and J. MILLS THE COST-EFFECTIVENESS OF PERMETHRIN-TREATED BED NETS IN AN AREA OF INTENSE MALARIA TRANSMISSION IN WESTERN KENYA Am J Trop Med Hyg, April 1, 2003; 68(90040): 161 - 167. [Abstract] [Full Text] [PDF]

				W. A. HAWLEY, F. O. TER KUILE, R. S. STEKETEE, B. L. NAHLEN, D. J. TERLOUW, J. E. GIMNIG, Y. P. SHI, J. M. VULULE, J. A. ALAII, A. W. HIGHTOWER, et al. IMPLICATIONS OF THE WESTERN KENYA PERMETHRIN-TREATED BED NET STUDY FOR POLICY, PROGRAM IMPLEMENTATION, AND FUTURE RESEARCH Am J Trop Med Hyg, April 1, 2003; 68(90040): 168 - 173. [Abstract] [Full Text] [PDF]