Insecticide-treated net (ITN) ownership, usage, and malaria transmission in the highlands of western Kenya

Abstract

BackgroundInsecticide-treated bed nets (ITNs) are known to be highly effective in reducing malaria morbidity and mortality. However, usage varies among households, and such variations in actual usage may seriously limit the potential impact of nets and cause spatial heterogeneity on malaria transmission. This study examined ITN ownership and underlying factors for among-household variation in use, and malaria transmission in two highland regions of western Kenya.MethodsCross-sectional surveys were conducted on ITN ownership (possession), compliance (actual usage among those who own ITNs), and malaria infections in occupants of randomly sampled houses in the dry and the rainy seasons of 2009.ResultsDespite ITN ownership reaching more than 71%, compliance was low at 56.3%. The compliance rate was significantly higher during the rainy season compared with the dry season (62% vs. 49.6%). Both malaria parasite prevalence (11.8% vs. 5.1%) and vector densities (1.0 vs.0.4 female/house/night) were significantly higher during the rainy season than during the dry season. Other important factors affecting the use of ITNs include: a household education level of at least primary school level, significantly high numbers of nuisance mosquitoes, and low indoor temperatures. Malaria prevalence in the rainy season was about 30% lower in ITN users than in non-ITN users, but this percentage was not significantly different during the dry season.ConclusionIn malaria hypo-mesoendemic highland regions of western Kenya, the gap between ITNownership and usage is generally high with greater usage recorded during the high transmission season. Because of the low compliance among those who own ITNs, there is a need to sensitize households on sustained use of ITNs in order to optimize their role as a malaria control tool.

Factors Associated with Sustained Use of Long-Lasting Insecticide-Treated Nets Following a Reduction in Malaria Transmission in Southern Zambia

“…Recent studies in Kenya and Tanzania also identified strong seasonality to LLIN use. 25,30,38 This seasonality in use may be related to temperature (LLINs are often described as uncomfortable to sleep under when it is hot) and mosquito density in households (LLIN use is higher when mosquitoes are present). Previous studies in Zanzibar, Kenya, and Ghana found the presence of culicine mosquitoes to be associated with LLIN use.…”

“…In Kenya, children aged 5-14 years reported significantly lower LLIN use. 38 School-based LLIN distributions and educational campaigns may help target this high-risk age group, especially if coupled with educational campaigns. Traditionally, LLINs are targeted to children younger than 5 years and pregnant women, often excluding older children.…”

Economic growth and under-five malaria mortality in Tanzania mainland: from correlation analysis to causality

“…Moreover, the results reveal that Granger causality run from ITNs to under-five malaria mortality. ITNs protect individuals from mosquito nuisance, suppress the vector population and reduce their ability to transmit malaria and are highly effective in reducing malaria morbidity and mortality (Atieli et al, 2011). However, the insignificant correlation association between ITNs and under-five malaria mortality might be due to usage of ITNs from one household member to other household member which can limit the potential impact of nets (Atieli et al, 2011).…”

Combining malaria control with rural electrification : social and behavioural factors that influenced the design, use and sustainability of solar-powered mosquito trapping systems (SMoTS) for malaria elimination on Rusinga Island, western Kenya

“…The mass distribution is reflected in more houses reporting having enough LLINs to cover every sleeping space at end line. Studies have reported mass distribution campaigns, especially when coupled with an awareness campaign of the benefits of using LLINs, as improving LLIN usage (Atieli, Zhou et al 2011;Zhou, Li et al 2014). While this positive improvement supports efforts towards malaria control, sustaining the changes may require a longer and persistent effort with educational programmes and cues to action.…”

“…Malaria awareness-raising, advocacy, case management, and prevention efforts have reaped the benefits of social science research and as a result, many programmes are implemented and evaluated in a more effective manner (Mwenesi 2005). Such studies have been conducted about: malaria treatment strategies (Snow, Peshu et al 1992;Mwenesi, Harpham et al 1995;Ruebush, Kern et al 1995;Marsh, Mutemi et al 2004;Zurovac, Rowe et al 2004;Abuya, Mutemi et al 2007); LLINs availability, acceptability, affordability and determinants of utilisation at household and community levels ; Alaii, Dye, Apondi et al 2010;Githinji, Herbst et al 2010;Hightower, Kiptui et al 2010;Atieli, Zhou et al 2011;Mutuku, Khambira et al 2013); and the economic cost of malaria (Meltzer, Terlouw et al 2003;Chuma, Thiede et al 2006). …”