Maintenance and sustained use of insecticide‐treated bednets and curtains three years after a controlled trial in western Kenya*

Abstract

In large experimental trials throughout Africa, insecticide-treated bednets and curtains have reduced child mortality in malaria-endemic communities by 15%-30%. While few questions remain about the efficacy of this intervention, operational issues around how to implement and sustain insecticide-treated materials (ITM) projects need attention. We revisited the site of a small-scale ITM intervention trial, 3 years after the project ended, to assess how local attitudes and practices had changed. Qualitative and quantitative methods, including 16 focus group discussions and a household survey (n = 60), were employed to assess use, maintenance, retreatment and perceptions of ITM and the insecticide in former study communities. Families that had been issued bednets were more likely to have kept and maintained them and valued bednets more highly than those who had been issued curtains. While most households retained their original bednets, none had treated them with insecticide since the intervention trial was completed 3 years earlier. Most of those who had been issued bednets repaired them, but none acquired new or replacement nets. In contrast, households that had been issued insecticide-treated curtains often removed them. Three (15%) of the households issued curtains had purchased one or more bednets since the study ended. In households where bednets had been issued, children 10 years of age and younger were a third as likely to sleep under a net as were adults (relative risk (RR) = 0. 32; 95% confidence interval (95%CI) = 0.19, 0.53). Understanding how and why optimal ITM use declined following this small-scale intervention trial can suggest measures that may improve the sustainability of current and future ITM efforts.

Assessing the Effect of a Combined Malaria Prevention Education and Free Insecticide-Treated Bed Nets Program on Self-Reported Malaria Among Children in a Conflict-Affected Setting in Northern Uganda

“…About 26 percent of households in the nation own at least one ITN, but significant disparities exist between urban and rural residents (MOH and ORC Macro, 2006). One key constraint to net ownership in Uganda, as in other parts of the sub-Saharan region, is limited affordability (Kachur, Phillips-Howard, Odhacha, Ruebush, Oloo, & Nahlen, 1999;Nuwaha, 2001). In the case of Northern Uganda, the 20-year internal conflict has decimated the living conditions and economic viability of the residents, leading to their increased vulnerability to malaria and other illnesses.…”

Use of electricity and malaria occurrence: Is there a link? The case of Malawi

“…The use of repellent soaked bed nets will reduce malaria, whereas non-treated bed nets may not constitute an effective prevention tool as they wear quickly and they may have holes, which provide entry points for malaria vectors (Holtz et al, 2002;Kachur et al, 1999). Television and radio ownership are expected to decrease malaria incidence by increasing household's members awareness of malaria, its causes and consequences.…”

The Electrification–Malaria Nexus: The Case of Rural Uganda

“…For example, in small-scale surveys carried out in Malawi and Kenya, between 80 and 90% of nets had holes (Holtz et al, 2002;Kachur et al, 1999). Television/radio ownership is expected to show that mass media and advertisements can increase the household awareness of malaria.…”