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The impact of insecticide (permethrin)-treated bed nets (ITNs) on malaria in pregnancy was studied in a rural area in western Kenya with intense perennial malaria transmission. All households in 40 of 79 villages were randomized to receive ITNs by January 1997. The ITNs were distributed in control villages two years later. Complete data on birth outcome were available on 2,754 (89.6%) of 3,072 deliveries. Women (n = 780) were followed monthly throughout pregnancy in 19 of 79 villages. Among gravidae 1–4, ITNs were associated with reductions of 38% (95% confidence interval [CI] = 17–54%) in the incidence of malaria parasitemia and 47% (95% CI = 6–71%) in the incidence of severe malarial anemia (hemoglobin level < 8 g/dL with parasitemia) during pregnancy. At the time of delivery, mean hemoglobin levels were 0.6 g/dL (95% CI = 0.01–1.2 g/dL) higher, the prevalence of placental or maternal malaria was reduced by 35% (95% CI = 20–47%), and the prevalence of low birth weight was reduced by 28% (95% CI = 2–47%) in gravidae 1–4 from ITN villages. No beneficial impact was observed in gravidae five or higher. In areas of intense perennial malaria transmission, permethrin-treated bed nets reduce the adverse effect of malaria during the first four pregnancies.
Acknowledgments: We express our gratitude to the women who participated in the study, and to the many people who assisted with this project. We thank Pauline Abdullah, Benta Kamire, Lucy Atieno, Christi Murray, Erik Schoute, Dr. Sue Binder, and Dr. Dan Colley for their continued support. We are grateful to Dr. Laurence Slutsker and Dr. Richard Steketee (Centers for Disease Control and Prevention) for reviewing this manuscript. We also thank the Director of the Kenya Medical Research Institute for his permission to publish this work.
Financial support: The ITN project was funded by the United States Agency for International Development. The Special Health Support Fund from the Royal Netherlands Embassy (Nairobi, Kenya) provided additional support for the study of the impact of ITN in pregnancy. Feiko O. ter Kuile and Dianne J. Terlouw were partly supported by a grant from the Netherlands Foundation for the Advancement of Tropical Research (WOTRO) (The Hague, The Netherlands). Jennifer F. Friedman was supported by a United States Fulbright Award.
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: Feiko O. ter Kuile, Dianne J. Terlouw, Penelope A. Phillips-Howard, William A. Hawley, Margarette S. Kolczak, and Altaf A. Lal, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mail-stop F-22, 4770 Buford Highway, Atlanta, GA 30341. Jennifer F. Friedman, International Health Institute, Brown University, Box B-G 495, Providence, RI 02912. Simon K. Kariuki, Ya Ping Shi, and John M. Vulule, Vector Biology and Control Research Centre, 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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