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Am. J. Trop. Med. Hyg., 68(4 suppl), 2003, pp. 23-29
Copyright © 2003 by The American Society of Tropical Medicine and Hygiene

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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

PENELOPE A. PHILLIPS-HOWARD, BERNARD L. NAHLEN, MARGARETTE S. KOLCZAK, ALLEN W. HIGHTOWER, FEIKO O. TER KUILE, JANE A. ALAII, JOHN E. GIMNIG, JOHN ARUDO, JOHN M. VULULE, AMOS ODHACHA, S. PATRICK KACHUR, ERIK SCHOUTE, DANIEL H. ROSEN, JOHN D. SEXTON, AGGREY J. OLOO, AND 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 Zoology, Kenyatta University, Nairobi, Kenya; Division of Parasitic Diseases, Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Office of Preventive Health, Kenyan Ministry of Health, Nairobi, Kenya

A group-randomized controlled trial of insecticide (permethrin)-treated bed nets (ITNs) was conducted in an area of high perennial malaria transmission in western Kenya to test the effect of ITNs on all-cause mortality in children 1–59 months of age. Child deaths were monitored over a two-year period by biannual household census in Asembo (1997–1998) and in Gem (1998–1999). Overall, 1,722 deaths occurred in children 1–59 months followed for 35,932 child-years. Crude mortality rates/1,000 child-years were 51.9 versus 43.9 in control and ITN villages in children 1–59 months old. The protective efficacy (PE) (95% confidence interval) adjusted for age, study year, study site, and season was 16% (6–25%). Corresponding figures in 1–11- and 12–59-month-old children in control and ITN villages were 133.3 versus 102.3, PE = 23% (11–34%) and 31.1 versus 28.7, PE = 7% (-6–19%). The numbers of lives saved/1,000 child-years were 8, 31, and 2 for the groups 1–59, 1–11, and 12–59 months old, respectively. Stratified analysis by time to insecticide re-treatment showed that the PE of ITNs re-treated per study protocol (every six months) was 20% (10–29%), overall and 26% (12–37%) and 14% (-1–26%) in 1–11- and 12–59-month-old children, respectively. ITNs prevent approximately one in four infant deaths in areas of intense perennial malaria transmission, but their efficacy is compromised if re-treatment is delayed beyond six months.

Acknowledgments: We express our gratitude to the villagers of Asembo and Gem for their participation in this trial. George Olang, Michael Onyango, Richard Otieno, Maurice Ombok, and Richard Odhiambo are thanked for their field management skills. We are grateful to Christi Murray, Benta Kamire, Pauline Abdallah, and the administrative team for the success of this project. We are grateful to John Paul Clark, Neen Alrutz, Dennis Carroll, and Mary Ettling of the U.S. Agency for International Development for their interest and support. We thank Drs. Laurence Slutsker, Richard Steketee, and Kevin DeCock for reviewing the manuscript. We also thank the Director of the Kenya Medical Research Institute for permission to publish this manuscript.

Financial support: The ITN project was funded 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. 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: Penelope A. Phillips-Howard, Margarette S. Kolczak, Allen W. Hightower, Feiko O. ter Kuile, John E. Gimnig, S. Patrick Kachur, John D. Sexton, and William A. Hawley, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. Jane A. Alaii, John Arudo, Amos Odhacha, Erik Schoute, Daniel H. Rosen, John Vulule, and Aggrey J. Oloo, Centre for Vector Biology Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.




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