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.
Highlights
Insecticide-treated bed nets (ITNs) are known to be highly effective in reducing malaria morbidity and mortality
The objective of this study was to examine the utilization of ITNs delivered by the Kenya Ministry of Health (MOH) facilities under routine operational conditions in areas of moderate to unstable/seasonal malaria transmission in two highlands sites in western Kenya
ITN usage and other factors Average number of human adults per house Average number of children per house Houses with ITNs (%) Average number of ITNs per house ITN usage in adults in houses owning ITN (%) ITN usage in children in houses owning ITN (%) ITN usage in adults: overall (%) ITN usage in children: overall (%) Percentage of people knows that ITN prevents malaria
Summary
Insecticide-treated bed nets (ITNs) are known to be highly effective in reducing malaria morbidity and mortality. Research indicates that the mechanisms leading to malaria transmission in the highlands are complex and are probably due to the combined effects of factors such as topography [20], hydrology [21], climate variability [22], landuse/land-cover change [23], and drug resistance [22]. Given these characteristics, ITNs are considered one of the most effective intervention strategies for the control of malaria across all age groups in the highland regions [15]
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