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.

Abstract

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.

• Authors: 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, William A Hawley
• Journal: The American journal of tropical medicine and hygiene (Am J Trop Med Hyg) Vol. 68 Issue 4 Suppl Pg. 23-9 (Apr 2003) ISSN: 0002-9637 [Print] United States
• PMID: 12749482 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Insecticides
• Permethrin

Topics

• Bedding and Linens
• Child
• Child, Preschool
• Confidence Intervals
• Geography
• Humans
• Infant
• Insecticides (pharmacology)
• Kenya (epidemiology)
• Malaria (epidemiology, mortality, prevention & control)
• Permethrin (pharmacology)
• Seasons