Abstract
BackgroundUnder 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.Methods5188 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.ResultsThe 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).ConclusionMalaria 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-1031-6) contains supplementary material, which is available to authorized users.
Highlights
Under trial conditions insecticide-treated nets have been shown to provide significant clinical and mortality protection under a range of malaria transmission intensity conditions
This study reports on a survey of malaria infection among Kenyan schoolchildren living in areas of intense malaria transmission and the relationship between infection in this age group and their reported use of insecticide-treated bed nets (ITN)
48.7 % of the children were positive for P. falciparum and 67.9 % reported having slept under an LLIN the night before the survey
Summary
Under trial conditions insecticide-treated nets have been shown to provide significant clinical and mortality protection under a range of malaria transmission intensity conditions. Achievements in increasing coverage of efficacious interventions have changed the landscape of transmission and disease burdens in some areas but this has not been universal between or within countries [1,2,3]. This impact diversity remains a challenge to the dogma that ‘one size fits all’ regarding the selection and optimization of control approaches. It has been proposed that where school attendance is high and malaria transmission is stable, the use of schoolbased malaria surveys offers a cheaper alternative to examine community-acquired infection prevalence and reported coverage of household vector control [7, 8]
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