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EFFECT OF SUSTAINED INSECTICIDE-TREATED BED NET USE ON ALL-CAUSE CHILD MORTALITY IN AN AREA OF INTENSE PERENNIAL MALARIA TRANSMISSION IN WESTERN KENYA

We present results from a study conducted in western Kenya where all-cause child mortality was assessed among a population with high levels of sustained insecticide-treated bed net (ITN) use for up to six years. Although ITNs were associated with significant reductions in all-cause mortality among infants 1–11 months old, there was no difference in the rate of all-cause mortality among children 12–59 months old with ITNs for 2–4 years, compared historically with children from villages without ITNs, after controlling for seasonality and underlying child mortality across calendar years (adjusted hazard ratio [AHR] = 0.91, 95% confidence interval [CI] = 0.77–1.07). There was no increase in the proportion of child deaths at older ages (12–59 months old) of all child deaths within villages with ITNs for 5–6 years (48.1%) compared historically with villages without ITNs (47.9%), after controlling for seasonality (AHR = 1.03, P = 0.834). We find no evidence that sustained ITN use increased the risk of mortality in older children in this area of intense perennial malaria transmission.

Received October 23, 2004. Accepted for publication January 9, 2005.

Acknowledgments: We express our gratitude to the villagers of Asembo and Gem for their participation in this research. George Olang, James Kwach, Michael Onyango, Richard Otieno, and Maurice Ombok are thanked for their field and data management skills. We are grateful to the Centers for Disease Control and Prevention/Kenya Medical Research Institute administrative team for their support. The Director of the Kenya Medical Research Institute is thanked for his permission to publish this manuscript.

Financial support: This research was supported 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.

^* Address correspondence to Thomas P. Eisele, Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA. E-mail: teisele{at}tulane.edu

Authors’ addresses: Thomas P. Eisele, Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, Telephone: 504-584-3655, E-mail: teisele{at}tulane.edu. Kim A. Lindblade, Kathleen A. Wannemuehler, John E. Gimnig, William A. Hawley, Penny Phillips-Howard, Daniel H. Rosen, and Laurence Slutsker, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341. Frank Odhiambo and John M. Vulule, Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya. Feiko O. ter Kuile, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, United Kingdom. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.