THE HOUSEHOLD-LEVEL ECONOMICS OF USING PERMETHRIN-TREATED BED NETS TO PREVENT MALARIA IN CHILDREN LESS THAN FIVE YEARS OF AGE

MARTIN I. MELTZER Office of Surveillance, Office of the Director, and 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 Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Search for other papers by MARTIN I. MELTZER in
Current site
Google Scholar
PubMed
Close
,
DIANNE J. TERLOUW Office of Surveillance, Office of the Director, and 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 Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Search for other papers by DIANNE J. TERLOUW in
Current site
Google Scholar
PubMed
Close
,
MARGARETTE S. KOLCZAK Office of Surveillance, Office of the Director, and 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 Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Search for other papers by MARGARETTE S. KOLCZAK in
Current site
Google Scholar
PubMed
Close
,
AMOS ODHACHA Office of Surveillance, Office of the Director, and 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 Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Search for other papers by AMOS ODHACHA in
Current site
Google Scholar
PubMed
Close
,
FEIKO O. TER KUILE Office of Surveillance, Office of the Director, and 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 Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Search for other papers by FEIKO O. TER KUILE in
Current site
Google Scholar
PubMed
Close
,
JOHN M. VULULE Office of Surveillance, Office of the Director, and 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 Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Search for other papers by JOHN M. VULULE in
Current site
Google Scholar
PubMed
Close
,
JANE A. ALAII Office of Surveillance, Office of the Director, and 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 Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Search for other papers by JANE A. ALAII in
Current site
Google Scholar
PubMed
Close
,
BERNARD L. NAHLEN Office of Surveillance, Office of the Director, and 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 Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Search for other papers by BERNARD L. NAHLEN in
Current site
Google Scholar
PubMed
Close
,
WILLIAM A. HAWLEY Office of Surveillance, Office of the Director, and 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 Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Search for other papers by WILLIAM A. HAWLEY in
Current site
Google Scholar
PubMed
Close
, and
PENELOPE A. PHILLIPS-HOWARD Office of Surveillance, Office of the Director, and 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 Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Search for other papers by PENELOPE A. PHILLIPS-HOWARD in
Current site
Google Scholar
PubMed
Close
Restricted access

We measured the two-week household-level economic impact of insecticide (permethrin)-treated bed nets (ITNs) used to prevent malaria among children less than five years of age in Asembo, Kenya. The ITNs induced a two-week reduction of 15 Kenyan shillings (KSH) (U.S. $0.25; P < 0.0001) in health care expenditures, but a statistically insignificant 0.5 day (P = 0.280) reduction in household time lost due to caring for sick children. The equivalent annual threshold cost was estimated at U.S. $6.50 (95% confidence interval = 3.12–9.86). If the actual purchase price and maintenance costs of ITNs were greater than this threshold, then households would pay more than they would save (and vice-versa). Both seasonal effects and number of children per household had larger impacts than ITNs on health care expenditures and time lost from household activities. Health care expenditures by a household without ITNs and one child were only 32 KSH per two weeks (U.S. $0.50; P = 0.002), leaving little opportunity for household-level, ITN-induced direct savings. The widespread adoption of the ITNs will therefore probably require a subsidy.

Author Notes

  • 1

    Gallup JL, Sachs JD, 2001. The economic burden of malaria. Am J Trop Med Hyg 64 (Suppl):85–96.

  • 2

    The World Bank, 2000. African Development Indicators 2000. Washington, DC: The World Bank.

    • PubMed
    • Export Citation
  • 3

    Habluetzel A, Diallo DA, Esposito F, Lamizana L, Pagnoni F, Lengler C, Trarore C, 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
  • 4

    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
  • 5

    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
  • 6

    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 345 :479–483.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    ter Kuile FO, Terlouw DJ, Phillips-Howard PA, Hawley WA, Friedman JF, Kolczak MS, Kariuki SK, Shi YP, Kwena AM, Vulule JM, Nahlen BL, 2003. 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. Am J Trop Med Hyg 68 (Suppl 4):100–107.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Phillips-Howard PA, Nahlen BL, Kolczak MS, Hightower AW, ter Kuile FO, Alaii JA, Gimnig JE, Arudo J, Vulule JM, Odacha 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
  • 10

    Goodman CA, Coleman PG, Mills A, 1999. Cost-effectiveness of malaria control in sub-Saharan Africa. Lancet 354 :378–385.

  • 11

    Picard J, Aikins M, Alonso PL, Armstrong Schellenberg JRM, Greenwood BM, Mills A, 1993. Cost-effectiveness of bed net impregnation alone or combined with chemoprophylaxis in preventing mortality and morbidity from malaria in Gambian children. Trans R Soc Trop Med Hyg 87 (Suppl 2):53–57.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Binka FN, Mensah OA, Mills A, 1997. The cost-effectiveness of permethrin impregnated bednets in preventing child mortality in Kassena-Nankana district of northern Ghana. Health Policy 41 :229–239.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Aikens MK, Fox-Rushby J, D’Alessandro U, Langerock P, Cham K, New L, Bennett S, Greenwood B, Mills A, 1998. The Gambian national impregnated bednet programme: Costs, consequences and net cost-effectiveness. Soc Sci Med 46 :181–191.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Goodman CA, Mnzava AEP, Dlamini SS, Sharp BL, Mthembu DJ, Gumede JK, 2001. Comparison of the cost and cost-effectiveness of insecticide-treated bednets and residual house-spraying in KwaZulu-Natal, South Africa. Trop Med Int Health 6 :280–295.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Evans DB, Azene G, Kitigia J, 1997. Should governments subsidize the use of insecticide-impregnated mosquito nets in Africa? Implications of a cost-effectiveness analysis. Health Policy Plann 12 :107–114.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Goodman CA, Mills AJ, 1999. The evidence base on the cost-effectiveness of malaria control in Africa. Health Policy Plann 14 :301–312.

  • 17

    Brinkmann U, Brinkmann A, 1995. Economic aspects of the use of impregnated mosquito nest for malaria control. Bull World Health Organ 73 :651–658.

  • 18

    Onwujekwe O, Chima R, Shu E, Nwagbo D, Okonkwo P, 2001. Hypothetical and actual willingness to pay for insecticide-treated nets in five Nigerian communities. Trop Med Int Health 6 :545–553.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Cropper ML, Haile M, Lampiett JA, Poulos C, Whittington D, 2001. The Value of Preventing Malaria in Tembien, Ethiopia. Washington, DC: The World Bank.

    • PubMed
    • Export Citation
  • 20

    Messonnier M, Meltzer MI, 2002. Cost-benefit analysis. Haddix A, Teutsch S, Corso P, eds. Prevention Effectiveness. Second edition. Oxford, United Kingdom: Oxford University Press, 127–155.

    • PubMed
    • Export Citation
  • 21

    Mills A, Fox-Rushby J, Aikins M, D’Alessandro U, Cham K, Greenwood B, 1994. Financing mechanisms for village activities in The Gambia and their implications for financing insecticide impregnation. J Trop Med Hyg 97 :325–332.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Mills A, 1998. Operational research on the economics of insecticide-treated mosquito nets: lessons of experience. Ann Trop Med Parasitol 92 :435–447.

  • 23

    Shepard DS, Ettling MB, Brinkmann U, Sauerborn R, 1991. The economic cost of malaria in Africa. Trop Med Parasitol 42 (Suppl 1):199–203.

  • 24

    Sauerborn R, Shepard DS, Ettling MB, Brinkmann U, Nougtara A, Diesfeld HJ, 1991. Estimating the direct and indirect economic costs of malaria in a rural district of Burkina Faso. Trop Med Parasitol 42 (Suppl 1):219–223.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Ettling M, McFarland DA, Schultz LJ, Chitsulo I, 1994. Economic impact of malaria in Malawian households. Trop Med Parasitol 45 :74–79.

  • 26

    Kennedy P, 1992. A Guide to Econometrics. Third edition. Cambridge, MA: The MIT Press.

    • PubMed
    • Export Citation
  • 27

    Koenker R, Hallock K, 2000. Quantile regression: An introduction. Available online at: www.econ.uiuc.edu/~roger/research/intro/intro.html.

    • PubMed
    • Export Citation
  • 28

    Nuwaha F, 2001. Factors influencing the use of bed nets in Mbarara municipality of Uganda. Am J Trop Med Hyg 65 :877–882.

  • 29

    Alaii JA, van den Borne HW, Kachur SP, Shelley K, Mwenesi H, Vulule JM, Hawley WA, Nahlen BL, Phillips-Howard PA, 2003. Community reactions to the introduction of permethrin-treated bed nets for malaria control during a randomized controlled trial in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):128–136.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Mwabu GM, 1988. Seasonality, the shadow price of time and effectiveness of tropical disease control programs. Herrin AN, Rosenfield PL, eds. Economics, Health and Tropical Diseases. Manilia, The Philippines: School of Economics, University of the Philippines, 259–270.

    • PubMed
    • Export Citation
  • 31

    Beier JC, Oster CN, Onyango FK, Bales JD, Sherwood JA, Perkins PV, Chumo DK, Koech DV, Whitmire RE, Roberts CR, 1994. Plasmodium falciparum incidence relative to entomologic inoculation rates at a site proposed for testing malaria vaccines in western Kenya. Am J Trop Med Hyg 50 :529–536.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    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
  • 33

    Cham MK, Olaleye B, D’Alessandro U, Aikins M, Cham B, Maine N, Williams LA, Mills A, Greenwood BM, 1997. The impact of charging for insecticide on the Gambian national impregnated bednet programme. Health Policy Plann 12 :240–247.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 1

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Phillips-Howard PA, ter Kuile FO, Nahlen BL, Alaii JA, Gimnig JE, Kolczak MS, Terlouw DJ, Kariuki S, Shi YP, Kachur SP, High-tower 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 of evaluation. Am J Trop Med Hyg 68 (Suppl 4):10–15.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 104 102 7
Full Text Views 389 4 0
PDF Downloads 38 2 0
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save