The western Kenya insecticide-treated bed net trial
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Prior to implementation of a randomized controlled trial of insecticide (permethrin)-treated bed nets (ITNs) in western Kenya, ethnographic studies were conducted to understand local perceptions of disease, sleeping patterns, and other factors that might affect use of ITNs. Educational activities took place prior to distribution, but immediately after distribution in Asembo only approximately half of the ITNs were in use. A qualitative study was then conducted to identify the community’s perceptions about ITNs and the ITN project. While participants ranked malaria as important and recognized that malaria prevention could be beneficial, they believed ITNs would be only partly effective due to the perception that malaria has multiple causes. Concerns expressed included fear of the insecticide, thought by some to be a toxic family planning aid, the taking of blood during clinical studies, and the mixing up of family ITNs during net re-treatment, which would violate cultural taboos. Attempts were made to allay fears by improved communication on these subjects and modification of the study design.


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  1. Choi HW, Breman JG, Teusch SM, Liu S, Hightower AW, Sexton JD, 1995. The effectiveness of insecticide impregnated bed nets in reducing cases of malaria infection: a meta-analysis of published results. Am J Trop Med Hyg 52 : 377–382. [Google Scholar]
  2. Lengeler C, 2000. Insecticide-treated bednets and curtains for preventing malaria. Cochrane Database Syst Rev 2 : CD000363. [Google Scholar]
  3. Alaii JA, 1997. The Relevance of Sleeping Arrangements and Bedtime Mobility Patterns for Implementing Insecticide-Treated Bednets in Asembo, Western Kenya. M.Sc. Dissertation. London: School of Education, Politics and Social Sciences, Faculty of Health Sciences, South Bank University.
  4. Lines J, 1996. The technical issues. Lengeler C, Cattani J, de Savigny DH, eds. Net Gain—A New Method for Preventing Malaria Deaths. Ottawa, Ontario, Canada: International Development Research Centre, 17–54.
  5. Phillips-Howard PA, ter Kuile FO, Nahlen BL, Alaii JA, Gimnig JE, Kolczak MS, Terlouw DJ, Kariuki SK, Shi YP, Kachur SP, Hightower AW, Vulule JM, Hawley WA, 2003. 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 68 (Suppl 4) : 10–15. [Google Scholar]
  6. NES, 1990. Participatory Rural Appraisal Handbook. National Environment Secretariat, Kenya; Clark University; Egerton University; and the Center for International Development and Environment of the World Resources Institute. Nairobi, Kenya: Government Printers.
  7. Cohen DW, Atieno-Odhiambo ES, 1989. Siaya: The Historical Anthropology of an African Landscape. London: James Currey, Ltd.
  8. Phillips-Howard PA, Nahlen BL, Alaii JA, ter Kuile FO, Gimnig JE, Ferlouw DJ, Kachur SP, Hightower AW, Lal AA, Schoute E, Oloo AJ, Hawley WA, 2003. The efficacy of permethrin treated bed nets on child mortality and morbidity in western Kenya I. Development of infrastructure and description of study site. Am J Trop Med Hyg 68 (Suppl 4) : 23–29. [Google Scholar]
  9. Sexton JD, Ruebush TO, Brandling-Bennett AD, Breman JG, Odera JS, Were SBO, 1990. Permethrin-impregnated curtains and bed nets prevent malaria in western Kenya. Am J Trop Med Hyg 43 : 11–18. [Google Scholar]
  10. Chambers R, 1994. The origins and practice of participatory rural appraisal. World Dev 22 : 953–969. [Google Scholar]
  11. Rogers EM, 1995. Diffusions of Innovations. Fourth edition. New York: The Free Press.
  12. Phillips-Howard PA, Nahlen BL, Kolczak MS, Hightower AW, ter Kuile FO, Alaii JA, Gimnig JE, Arudo J, Vulule JM, Odhacha A, Kachur SP, Schoute E, Rosen DH, Sexton JD, Oloo AJ, Hawley WA, 2003. 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 68 (Suppl 4) : 23–29. [Google Scholar]
  13. Alaii JA, Hawley WA, Kolczak MS, ter Kuile FO, Gimnig JE, Vulule JM, Odhacha A, Oloo AJ, Nahlen BL, Phillips-Howard PA, 2003. Factors affecting use of permethrin-treated bed nets during a randomized-controlled trial in western Kenya. Am J Trop Med Hyg 68 (Suppl 9) : 137–141. [Google Scholar]
  14. Winch PJ, Makemba AM, Kamazima SR, Lwihula GK, Lubega P, Minjas JN, Shiff CJ, 1994. Seasonal variation in the perceived risk of malaria: implications for the promotion of insecticide-treated bed nets. Soc Sci Med 39 : 63–75. [Google Scholar]
  15. D’Alessandro U, Olaleye BO, McGuire W, Langerock P, Bennett S, Aikins MK, Thomson MC, Cham MK, Cham BA, Greenwood BM, 1995. Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bednet programme. Lancet 354 : 479–483. [Google Scholar]
  16. Binka FN, Adongo P, 1997. Acceptability and use of insecticide impregnated bednets in northern Ghana. Trop Med Int Health 2 : 499–507. [Google Scholar]
  17. Basakaran S, Kalyanasandaram M, Das LK, Das PK, 1992. Preliminary evaluation of safety aspects in mosquito net impregnation with lambda cyhalothrin. Indian J Med Res 95 : 47–48. [Google Scholar]
  18. Oaks SC, Mitchell VS, Pearson GW, Carpenter CCJ, eds. Malaria: Obstacles and Opportunities—A Report of the Committee for the Study on Malaria Prevention and Control: Status Review and Alternative Strategies. Washington, DC: National Academy Press, Division of International Health, Institute of Medicine.
  19. Brieger WR, Onyido AE, Sexton JD, Ezike VI, Breman JG, Ekanem OJ, 1996. Monitoring community response to malaria control using insecticide-treated bed nets, curtains and residual spray at Nsukka, Nigeria. Health Educ Res 11 : 133–145. [Google Scholar]
  20. Gimnig JE, Vulule JM, Lo TQ, Kamau L, Kolczak MS, Phillips-Howard PA, Mathenge EM, ter Kuile FO, Nahlen BL, Hightower AW, Hawley WA, 2003. Impact of permethrin-treated bed nets on entomologic indices in an area of intense year-round malaria transmission. Am J Trop Med Hyg 68 (Suppl 4) : 100–107. [Google Scholar]
  21. Meltzer MI, Terlouw DJ, Kolczak MS, Odhacha A, ter Kuile FO, Vulule JM, Alaii JA, Nahlen BL, Hawley WA, Phillips-Howard PA, 2003. The household-level economics of using permethrin-treated bed nets to prevent malaria in children less than five years of age. Am J Trop Med Hyg 68 (Suppl 4) : 149–160. [Google Scholar]
  22. Snow RE, McCabe E, Mbogo CNM, Molyneux CS, Some ES, Mung’ala VO, Nevill CG, 1999. The effect of delivery mechanisms on uptake of bednet re-impregnation in Kilifi District, Kenya. Health Policy Plann 14 : 18–25. [Google Scholar]
  23. Kachur SP, Phillips-Howard PA, Odhacha AM, Ruebush TK, Oloo AJ, Nahlen BL, 1999. Maintenance and sustained use of insecticide treated bednets and curtains three years after a controlled trial in western Kenya. Trop Med Int Health 4 : 728–735. [Google Scholar]
  24. Rozendaal JA, 1989. Impregnated mosquito nets and curtains for self-protection and vector control. Trop Dis Bull 86 : R29–R30. [Google Scholar]

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