Implications of the western Kenya permethrin-treated bed net study for policy, program implementation, and future research.
The fifth, and probably last, large-scale, group-randomized, controlled trial of insecticide (permethrin)-treated bed nets (ITNs) showed that ITNs are efficacious in reducing all-cause post-neonatal mortality in an area of intense, perennial malaria transmission. The trial helped to define pregnant women and infants as target groups for this intervention in high transmission settings. High population coverage with ITNs in both target and non-target groups may be critical to enhance health and survival in pregnant women and infants. The proportion of households with ITNs (coverage), the proportion of individuals properly deploying ITNs each night (adherence), and the proportion of nets properly treated with insecticide (treatment) are the three key determinants of effectiveness of large-scale ITN programs. These three simple outcomes should serve as the basis for program objectives and monitoring and evaluation efforts. Coverage effects and economic analysis support the proposition that ITNs may be viewed as a public good, worthy of public support. Research should continue to improve the intervention tools (the net, the insecticide, and methods for durable treatment and re-treatment) and their deployment.
Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya.
William A
WA
Hawley
Feiko O
FO
ter Kuile
Richard S
RS
Steketee
Bernard L
BL
Nahlen
Dianne J
DJ
Terlouw
John E
JE
Gimnig
Ya Ping
YP
Shi
John M
JM
Vulule
Jane A
JA
Alaii
Allen W
AW
Hightower
Margarette S
MS
Kolczak
Simon K
SK
Kariuki
Penelope A
PA
Phillips-Howard
D000818:Animals; D005260:Female; D006266:Health Education; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007306:Insecticides / Q000494:pharmacology; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D026023:Permethrin / Q000494:pharmacology*; D011247:Pregnancy; D012106:Research / Q000639:trends*
D007306:Insecticides; D026023:Permethrin