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IMPACT OF PERMETHRIN-TREATED BED NETS ON GROWTH, NUTRITIONAL STATUS, AND BODY COMPOSITION OF PRIMARY SCHOOL CHILDREN IN WESTERN KENYA

Insecticide-treated bed nets (ITNs) have been demonstrated to reduce morbidity and mortality in children less than five years of age. They have also been shown to improve the nutritional status of these children, but little is known about their impact on the nutritional status of school-age children. We evaluated the impact of ITNs on growth, nutritional status, and body composition of primary schoolchildren less than 13 years of age living in an area of intense perennial malaria transmission in western Kenya. The ITNs did not have a significant impact on linear growth or summary measures of protein-energy malnutrition in this age group. This lack of efficacy most likely relates to the reduced burden of malaria in this age group in a setting of stable transmission pressure. Use of ITNs was associated with a change in body composition with an increase in percent lean body mass (1.2%; P = 0.04). This may be consequent to reduced exposure to malaria with subsequent reduced elaboration of pro-inflammatory cytokines known to promote muscle wasting.

Acknowledgments: We thank the Centers for Disease Control and Prevention/Kenya Medical Research Institute field teams and support staff for their assistance with this project; the students, teachers, and headmasters for their time and participation; and Sidney Atwood and Philippe Jacob (Harvard School of Public Health) for their technical support. We also thank the Director of the Kenya Medical Research Institute for his permission to publish this work.

Financial support: This project was funded by the United States Agency for International Development. Jennifer F. Friedman was supported by a United States Fulbright Award. Dianne J. Terlouw and Feiko O. ter Kuile were supported in part by a grant from the Netherlands Foundation for the Advancement of Tropical Research (WOTRO) (The Hague, The Netherlands).

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: Jennifer F. Friedman, International Health Institute, Brown University, Box G-B495, Providence, RI 02912, Telephone: 401-863-2172, Fax: 401-863-1243, E-mail: Jennifer_Friedman@ Brown.edu. Penelope A. Phillips-Howard, William A. Hawley, Dianne J. Terlouw, Margarette S. Kolczak, and Feiko O. ter Kuile, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341, Telephone: 770-488-7760, Fax: 770-488-4206. Marlene Barber, Centre for Public Health, School of Medical Education, University of New South Wales, New South Wales 2052, Australia, Telephone: 61-2-9385-2507, Fax: 61-2-9385-1526. Norman Okello and John M. Vulule, Vector Biology and Control Research Centre, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. Christopher Duggan, Division of Gastroenterology and Nutrition, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, Telephone: 617-355-7612, Fax: 617-713-2892, E-mail: christopher.duggan{at}tch.harvard.edu. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland, Roll Back Malaria, World Health Organization, 1211 Geneva 27, Switzerland.

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