Abstract
BackgroundUse of bednets reduces malaria morbidity and mortality. In Kilifi, Kenya, there was a mass distribution of free nets to children < 5 years in 2006. In 2009, a new policy was implemented to offer bednets to pregnant women and children < 5 years free of charge. Nets were again distributed to children and adults through national mass campaigns in 2012 and 2015. We aimed to evaluate trends in bednet ownership and usage, and the effect of bednets on the incidence of malaria hospitalization in children < 5 years within the Kilifi Health and Demographic Surveillance System (KHDSS).MethodsBednet ownership and usage were assessed during eight routine enumeration rounds of the KHDSS between 2008 and 2015. Malaria admissions (i.e. admissions to hospital with P. falciparum > 2500 parasitemia per μl) among children < 5 years were captured using a system of continuous vital registration that links admissions at Kilifi County Hospital to the KHDSS population register. Survival analysis was used to assess relative risk of hospitalization with malaria among children that reported using a bednet compared to those who did not.ResultsWe observed 63% and 62% mean bednet ownership and usage, respectively, over the eight-survey period. Among children < 5 years, reported bednet ownership in October–December 2008 was 69% and in March–August 2009 was 73% (p < 0.001). An increase was also observed following the mass distribution campaigns in 2012 (62% in May–July 2012 vs 90% in May–October 2013, p < 0.001) and 2015 (68% in June–September 2015 vs 93% in October–November 2015, p < 0.001). Among children <5 years who reported using a net the night prior to the survey, the incidence of malaria hospitalization per 1000 child-years was 2.91 compared to 4.37 among those who did not (HR = 0.67, 95% CI: 0.52, 0.85 [p = 0.001]).ConclusionOn longitudinal surveillance, increasing bednet ownership and usage corresponded to mass distribution campaigns; however, this method of delivering bednets did not result in sustained improvements in coverage. Among children < 5 years old bednet use was associated with a 33% decreased incidence of malaria hospitalization.
Highlights
Use of bednets reduces malaria morbidity and mortality
There was a strong association between reported bednet ownership and usage between 2008 and 2015 (Spearman’s rho = 0.9498; p < 0.001)
The overall proportion of bednet ownership in 2008 was 58% and in 2015 was 57% prior to the distribution campaign and 91% thereafter, with similar results observed for reported bednet usage (Fig. 2)
Summary
Use of bednets reduces malaria morbidity and mortality. In Kilifi, Kenya, there was a mass distribution of free nets to children < 5 years in 2006. In 2005, subsidized nets were made available to children and pregnant women through maternal and child health clinics, and in September 2006, a free bednet distribution campaign by the Kilifi District Health Management Team increased coverage across Kilifi county from about 0.25 to 0.5 insecticide-treated nets per person [15]. Bednets continued to be provided to the community through maternal and child health clinics at a cost of 50 Kenyan Shillings (~ $0.50) This was the case until January 2009, when a new policy was implemented to offer bednets at government health clinics to pregnant women and children aged < 5 years free of charge and to the rest of the population for 50 Kenyan Shillings. Bednets were again distributed through mass campaigns in July 2012 and in October 2015 as part of the efforts of achieving universal coverage for people at risk of malaria
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