title: Comparing insecticide-treated bed net use to Plasmodium falciparum infection among schoolchildren living near Lake Victoria, Kenya.
abstract: BACKGROUND
  Under trial conditions insecticide-treated nets have been shown to provide significant clinical and mortality protection under a range of malaria transmission intensity conditions. There are, however, few operational impact data, notably in very intense transmission conditions. This study, reports on malaria infection among Kenyan schoolchildren living in areas of intense malaria transmission and their reported use of insecticide-treated bed nets.
  
  
  METHODS
  5188 children in 54 schools were randomly sampled from seven counties surrounding Lake Victoria between May and June 2014. A questionnaire was administered to schoolchildren in classes 2-6 on the use of a long-lasting, insecticide-treated net (LLIN) the night before the survey and provided a single blood sample for a rapid diagnostic test for malaria infection. Analysis of the impact of insecticide-treated net use on malaria prevalence was undertaken using a multivariable, mixed effects, logistic regression at 95% confidence interval (CI), taking into account hierarchical nature of the data and results adjusted for school clusters.
  
  
  RESULTS
  The overall prevalence of malaria infection was 48.7%, two-thirds (67.9%) of the children reported using LLIN, 91.3% of the children reported that their households own at least one LLIN and the household LLIN coverage was 2.5 persons per one LLIN. The prevalence of infection showed variation across the counties, with prevalence being highest in Busia (66.9%) and Homabay (51.8%) counties, and lowest in Migori County (29.6%). Generally, malaria parasite prevalence differed between age groups and gender with the highest prevalence occurring in children below 7 years (50.6%) and males (52.2%). Adjusting for county and school, there was a significant reduction in odds of malaria infection among the schoolchildren who reported LLIN use the previous night by 14 % (aOR 0.86, 95% CI 0.74-0.98, P < 0.027).
  
  
  CONCLUSIONS
  Malaria transmission continues to be high around Lake Victoria. Despite evidence of increasing pyrethroid resistance and the likely overall efficacy of LLIN distributed several years prior to the survey, LLIN continue to provide protection against infection among school-aged children.
authors.affiliation: Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya. comondi@kemri.org.
authors.forename: Collins
authors.initials: C
authors.lastname: Okoyo
authors.affiliation: Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya. CMwandawiro@kemri.org.
authors.forename: Charles
authors.initials: C
authors.lastname: Mwandawiro
authors.affiliation: Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya. jimmykihara09@gmail.com.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Kihara
authors.affiliation: Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya. ewanyonyi@kemri.org.
authors.forename: Elses
authors.initials: E
authors.lastname: Simiyu
authors.affiliation: Spatial Health Metrics Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya. caroline.gitonga1@gmail.com.|ICF-Measure Programme, Nairobi, Kenya. caroline.gitonga1@gmail.com.
authors.forename: Caroline W
authors.initials: CW
authors.lastname: Gitonga
authors.affiliation: Spatial Health Metrics Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya. ANoor@kemri-wellcome.org.|Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. ANoor@kemri-wellcome.org.
authors.forename: Abdisalan M
authors.initials: AM
authors.lastname: Noor
authors.affiliation: Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya. SNjenga@kemri.org.
authors.forename: Sammy M
authors.initials: SM
authors.lastname: Njenga
authors.affiliation: Spatial Health Metrics Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya. rsnow@kemri-wellcome.org.|Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. rsnow@kemri-wellcome.org.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
mesh_terms: D000293:Adolescent; D002648:Child; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D009032:Mosquito Control / Q000379:methods*; D015995:Prevalence; D012574:Schools; D013334:Students; D011795:Surveys and Questionnaires