IMPACT OF PERMETHRIN-TREATED BED NETS ON MALARIA AND ALL-CAUSE MORBIDITY IN YOUNG CHILDREN IN AN AREA OF INTENSE PERENNIAL MALARIA TRANSMISSION IN WESTERN KENYA: CROSS-SECTIONAL SURVEY

FEIKO O. TER KUILE Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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DIANNE J. TERLOUW Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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PENELOPE A. PHILLIPS-HOWARD Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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WILLIAM A. HAWLEY Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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JENNIFER F. FRIEDMAN Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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MARGARETTE S. KOLCZAK Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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SIMON K. KARIUKI Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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YA PING SHI Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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ARTHUR M. KWENA Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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JOHN M. VULULE Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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BERNARD L. NAHLEN Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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Information on the impact of insecticide (permethrin)-treated bed nets (ITNs) from randomized controlled trials in areas of intense perennial malaria transmission is limited. As part of a large-scale, community-based, group-randomized controlled trial of the effect of ITNs on childhood mortality in a holoendemic area in western Kenya, we conducted three cross-sectional surveys in 60 villages to assess the impact of ITNs on morbidity in 1,890 children less than three years old. Children in ITN and control villages were comparable pre-intervention, but after the introduction of ITNs, children in intervention villages were less likely to have recently experienced illness requiring treatment (protective efficacy [95% confidence intervals] = 15% [1–26%]), have an enlarged spleen (32% [20–43%]), be parasitemic (19% [11–27%]), have clinical malaria (44% [6–66%]), have moderately severe anemia (hemoglobin level < 7.0 g/dL; 39% [18–54%]), or have a pruritic body rash, presumably from reduced nuisance insect bites (38% [24–50%]). Use of ITNs was also associated with significantly higher mean weight-for-age Z-scores and mid-upper arm circumferences. There was no evidence, however, that ITNs reduced the risk of helminth infections, diarrhea, or upper or lower respiratory tract infections. The ITNs substantially reduced malaria-associated morbidity and improved weight gain in young children in this area of intense perennial malaria transmission.

Author Notes

  • 1

    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 bed-net programme. Lancet 345 :479–483.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Binka FN, Kubaje A, Adjuik M, Williams LA, Lengeler C, Maude GH, Armah GE, Kajihara B, Adiamah JH, Smith PG, 1996. Impact of permethrin impregnated bednets on child mortality in Kassena-Nankana district, Ghana: a randomized controlled trial. Trop Med Int Health 1 :147–154.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Nevill CG, Some ES, Mung’ala VO, Mutemi W, New L, Marsh K, Lengeler C, Snow RW, 1996. Insecticide-treated bednets reduce mortality and severe morbidity from malaria among children on the Kenyan coast. Trop Med Int Health 1 :139–146.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Habluetzel A, Diallo DA, Esposito F, Lamizana L, Pagnoni F, Lengeler C, Traore C, Cousens SN, 1997. Do insecticide-treated curtains reduce all-cause child mortality in Burkina Faso? Trop Med Int Health 2 :855–862.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Schellenberg JR, Abdulla S, Nathan R, Mukasa O, Marchant TJ, Kikumbih N, Mushi AK, Mponda H, Minja H, Mshinda H, Tanner M, Lengeler C, 2001. Effect of large-scale social marketing of insecticide-treated nets on child survival in rural Tanzania. Lancet 357 :1241–1247.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Lengeler C, 2000. Insecticide-treated bednets and curtains for preventing malaria. Cochrane Database Syst Rev 320 :CD000363.

  • 8

    Sexton JD, Ruebush TK 2nd, Brandling-Bennett AD, Breman JG, Roberts JM, Odera JS, Were JB, 1990. Permethrin-impregnated curtains and bed-nets prevent malaria in western Kenya. Am J Trop Med Hyg 43 :11–18.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Fraser-Hurt N, Felger I, Edoh D, Steiger S, Mashaka M, Masanja H, Smith T, Mbena F, Beck HP, 1999. Effect of insecticide-treated bed nets on haemoglobin values, prevalence and multiplicity of infection with Plasmodium falciparum in a randomized controlled trial in Tanzania. Trans R Soc Trop Med Hyg 93 (Suppl 1):47–51.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Abdulla S, Schellenberg JA, Nathan R, Mukasa O, Marchant T, Smith T, Tanner M, Lengeler C, 2001. Impact on malaria morbidity of a programme supplying insecticide treated nets in children aged under 2 years in Tanzania: community cross sectional study. BMJ 322 :270–273.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Premji Z, Lubega P, Hamisi Y, McHopa E, Minjas J, Checkley W, Shiff C, 1995. Changes in malaria associated morbidity in children using insecticide treated mosquito nets in the Bagamoyo district of coastal Tanzania. Trop Med Parasitol 46 :147–153.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Beach RF, Ruebush TK 2nd, Sexton JD, Bright PL, Hightower AW, Breman JG, Mount DL, Oloo AJ, 1993. Effectiveness of permethrin-impregnated bed nets and curtains for malaria control in a holoendemic area of western Kenya. Am J Trop Med Hyg 49 :290–300.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Meltzer MI, Terlouw DJ, Kolczak MS, Odhacha A, ter Kuile FO, Vulule JM, Alaii JA, Nahlen BL, Hawley WA, 2003. Phillips-Howard PA, The household-level economics of using permethrin-treated bednets to prevent malaria in children under 5 years of age. Am J Trop Med Hyg 68 (Suppl 4):149–160.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Phillips-Howard PA, Nahlen BL, Alaii JA, ter Kuile FO, Gimnig JE, Terlouw DJ, Kachur SP, Hightower AW, Lal AA, Schoute E, Oloo AJ, Hawley WA, 2003. The efficacy of permethrin-treated bednets 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):3–9.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Bloland PB, Ruebush TK, McCormick JB, Ayisi J, Boriga DA, Oloo AJ, Beach R, Hawley W, Lal A, Nahlen B, Udhayakumar V, Campbell CC, 1999. Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission I. Description of study site, general methodology, and study population. Am J Trop Med Hyg 60 :635–640.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    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 bednets on child mortality and morbidity in western Kenya. II: Study design and methods. Am J Trop Med Hyg 68 (Suppl 4):10–15.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Gimnig JE, Vulule JM, Lo TQ, Kamau L, Kolczak MS, Phillips-Howard PA, Mathenge EM, ter Kuile FO, Nahlen BL, High-tower AW, Hawley WA, 2003. Impact of permethrin-treated bednets on entomological indices in an area of intense year round malaria transmission. Am J Trop Med Hyg 68 (Suppl 4):16–22.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Kwena AM, Terlouw DJ, de Vlas SJ, Phillips-Howard PA, Hawley WA, Friedman JF, Vulule JM, Nahlen BL, Sauerwein RW, ter Kuile FO, 2003. Prevalence and severity of malnutrition in pre-school children in a rural area in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):94–99.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    McElroy PD, ter Kuile FO, Hightower AW, Hawley WA, Phillips-Howard PA, Oloo AJ, Lal AA, Nahlen BL, 2001. All-cause mortality among young children in western Kenya. VI: the Asembo Bay Cohort Project. Am J Trop Med Hyg 64 :18–27.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    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 bednets during a randomised-controlled trial in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):137–141.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Bindari-Hammad EL, Smith DL, 1992. Sampling for primary health care reviews. Primary health care reviews: Guidelines and methods. Geneva: World Health Organization, 153–179.

    • PubMed
    • Export Citation
  • 22

    Hawley WA, Phillips-Howard PA, ter Kuile FO, Terlouw DJ, Vulule JM, Ombok M, Nahlen BL, Gimnig JE, Kariuki SK, Kolczak MS, Hightower AW, 2003. Community-wide effects of permethrin-treated bednets on child mortality and malaria morbidity in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):121–127.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    United Nations, 1986. How to weigh and measure children: Assessing the nutritional status of young children in household surveys. New York: United Nations Department of Technical Cooperation for Development and Statistical Office.

    • PubMed
    • Export Citation
  • 24

    Knight WB, Hiatt RA, Cline BL, Ritchie LS, 1976. A modification of the formol-ether concentration technique for increased sensitivity in detecting Schistosoma mansoni eggs. Am J Trop Med Hyg 25 :818–823.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Katz N, Chaves A, Pellegrino J, 1972. A simple device for quantitative stool thick-smear technique in Schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 14 :397–400.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Hamill PVV, Drizd TA, Johnson CL, Reed RB, Roche AF, Moore WM, 1979. Physical growth: National Center for Health Statistics percentiles. Am J Clin Nutr 32 :607–629.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Hardin J, Hilbe J, 2001. Generalized Linear Models and Extensions. Texas: Stata Press.

    • PubMed
    • Export Citation
  • 28

    Skov T, Deddens J, Petersen MR, Endahl L, 1998. Prevalence proportion ratios: estimation and hypothesis testing. Int J Epidemiol 27 :91–95.

  • 29

    Bloland PB, Boriga DA, Ruebush TK, McCormick JB, Roberts JM, Oloo AJ, Hawley W, Lal A, Nahlen B, Campbell CC, 1999. Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission II. Descriptive epidemiology of malaria infection and disease among children. Am J Trop Med Hyg 60 :641–648.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Habluetzel A, Cuzin N, Diallo DA, Nebie I, Belem S, Cousens SN, Esposito F, 1999. Insecticide-treated curtains reduce the prevalence and intensity of malaria infection in Burkina Faso. Trop Med Int Health 4 :557–564.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Magbity EB, Marbiah NT, Maude G, Curtis CF, Bradley DJ, Greenwood BM, Petersen E, Lines JD, 1997. Effects of community-wide use of lambdacyhalothrin-impregnated bednets on malaria vectors in rural Sierra Leone. Med Vet Entomol 11 :79–86.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    ter Kuile FO, Terlouw DJ, Kariuki SK, Phillips-Howard PA, Mirel LB, Hawley WA, Friedman JF, Shi YP, Kolczak MS, Lal AA, Vulule JM, Nahlen BL, 2003. Impact of permethrin-treated bednets on malaria, anemia, and growth in infants in an area of intense perennial malaria transmission in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):68–77.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Shiff C, Checkley W, Winch P, Premji Z, Minjas J, Lubega P, 1996. Changes in weight gain and anaemia attributable to malaria in Tanzanian children living under holoendemic conditions. Trans R Soc Trop Med Hyg 90 :262–265.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    ter Kuile FO, Nosten F, Luxemburger C, Kyle D, Teja-Isavatharm P, Phaipun L, Price R, Chongsuphajaisiddhi T, White NJ, 1995. Mefloquine treatment of acute falciparum malaria: a prospective study of non-serious adverse effects in 3673 patients. Bull World Health Organ 73 :631–642.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Temu EA, Minjas JN, Shiff CJ, Majala A, 1999. Bedbug control by permethrin-impregnated bednets in Tanzania. Med Vet Entomol 13 :457–459.

  • 36

    Lindsay SW, Snow RW, Armstrong JR, Greenwood BM, 1989. Permethrin-impregnated bednets reduce nuisance arthropods in Gambian houses. Med Vet Entomol 3 :377–383.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Charlwood JD, Dagoro H, 1989. Collateral effects of bednets impregnated with permethrin against bedbugs (Cimicidae) in Papua New Guinea. Trans R Soc Trop Med Hyg 83 :261.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Howard SC, Omumbo J, Nevill C, Some ES, Donnelly CA, Snow RW, 2000. Evidence for a mass community effect of insecticide-treated bednets on the incidence of malaria on the Kenyan coast. Trans R Soc Trop Med Hyg 94 :357–360.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Binka FN, Indome F, Smith T, 1998. Impact of spatial distribution of permethrin-impregnated bed nets on child mortality in rural northern Ghana. Am J Trop Med Hyg 59 :80–85.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Ilboudo-Sanogo E, Cuzin-Ouattara N, Diallo DA, Cousens SN, Esposito F, Habluetzel A, Sanon S, Ouedraogo AP, 2001. Insecticide-treated materials, mosquito adaptation and mass effect: entomological observations after five years of vector control in Burkina Faso. Trans R Soc Trop Med Hyg 95 :353–360.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Gimnig JE, Kolczak MS, Hightower AW, Vulule JM, Schoute E, Kamau L, Phillips-Howard PA, ter Kuile FO, Nahlen BL, Hawley WA, 2003. Effect of permethrin-treated bed nets on the spatial distribution of malaria vectors in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):115–120.

    • PubMed
    • Search Google Scholar
    • Export Citation
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