The use of insecticide-treated bednets (ITNs) leads to a 44% reduction in child mortality. Further, a combined approach of social marketing and free distribution of ITNs leads to child survival effects that are similar to those seen in previous randomised controlled trials. These are the conclusions of authors of an Article published in this week's edition of The Lancet.
ITN coverage in Kenya has increased rapidly from 7% in 2004 to 67% in 2006. Dr Greg Fegan, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya and colleagues studied 3500 children aged under-5-years once a year over three years. The children were based in 72 rural clusters in four districts of Kenya.
They found that the estimated rate of mortality in children reported to have used a recently treated bednet was 56% of that for children who did not use an ITN, a protective efficacy of 44%.
The authors say: "Using these estimates of protection, we estimate that the scaling-up of ITN coverage might have averted seven deaths for every 1000 ITNs used. However, there is considerable mortality variation by area - the effects were greatest in areas of reported high malaria transmission."
They conclude by saying they are confident a substantial effect on child survival was achieved during the expansion phase of the ITN strategy and might have reduced by a third the numbers of childhood deaths in high coverage districts in 2006. They say: "Donor agencies should regard this as money well spent and recognise that the challenge is now to maintain and increase funding to expand coverage further."
In an accompanying Comment, Professors Christian Lengeler and Don deSavigny, Swiss Tropical Institute, Basel, Switzerland, say: "With this work, the use of insecticide-treated bednets is confirmed as a major child-survival intervention in malaria-endemic settings in sub-Saharan Africa. The ongoing switch to long-lasting insecticidal bednets will further reinforce this intervention."
This paper can be viewed at the link below