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Impact of permethrin impregnated bednets on child mortality in Kassena-Nankana district, Ghana: a randomized
Insights
Permethrin-treated bednets significantly reduced child mortality by 17% in rural Ghana. This community-based trial highlights the effectiveness of insecticide-treated nets in malaria control programs.
Area of Science:
- Public Health
- Tropical Medicine
- Epidemiology
Background:
- Malaria remains a leading cause of child mortality in sub-Saharan Africa.
- Insecticide-treated nets (ITNs) are a key intervention, but their impact requires evaluation in diverse settings.
- Northern Ghana experiences intense malaria transmission with minimal traditional bednet use.
Purpose of the Study:
- To assess the impact of permethrin-impregnated bednets on all-cause child mortality.
- To evaluate the effectiveness of ITNs in an area with high malaria transmission and no prior bednet usage.
- To determine compliance and identify factors influencing mortality reduction.
Main Methods:
- A community-based randomized controlled trial was conducted in rural northern Ghana (1993-1995).
- Households in 48 randomly selected areas received permethrin-impregnated bednets, re-treated every six months.
- A longitudinal demographic surveillance system monitored births, deaths, and migrations to assess child mortality and compliance.
Main Results:
- Permethrin-impregnated bednets were associated with a 17% reduction in all-cause mortality in children aged 6 months to 4 years (RR=0.83, P=0.05).
- The mortality reduction was primarily observed in children aged two years and younger.
- Greater reductions occurred during the wet season (July-December) and its immediate aftermath, periods of high malaria transmission.
Conclusions:
- Community-based distribution and high compliance with permethrin-impregnated bednets significantly reduce child mortality in high malaria transmission areas.
- The findings support the widespread implementation of ITN programs for malaria control in sub-Saharan Africa.
- Seasonal variations in impact suggest targeted deployment or intensified use during peak malaria transmission seasons may be beneficial.
Abstract:
A community-based randomized, controlled trial of permethrin impregnated bednets was carried out in a rural area of northern Ghana, between July 1993 and June 1995, to assess the impact on the mortality of young children in an area of intense transmission of malaria and no tradition of bednet use. The district around Navrongo was divided into 96 geographical areas and in 48 randomly selected areas households were provided with permethrin impregnated bednets which were re-impregnated every 6 months. A longitudinal demographic surveillance system was used to record births, deaths and migrations, to evaluate compliance and to measure child mortality. The use of permethrin impregnated bednets was associated with 17% reduction in all-cause mortality in children aged 6 months to 4 years (RR = 0.83; 95% CI 0.69-1.00; P = 0.05). The reduction in mortality was confined to children aged 2 years of younger, and was greater in July-December, during the wet season and immediately after (RR = 0.79; 95% CI 0.63-1.00), a period when malaria mortality is likely to be increased, than in the dry season (RR = 0.92, 95% CI 0.73-1.14). The ready acceptance of bednets, the high level of compliance in their use and the subsequent impact on all-cause mortality in this study has important implications for programmes to control malaria in sub-Saharan Africa.