Effect of expanded insecticide-treated bednet coverage on child survival in rural Kenya: a longitudinal study
Open accessAbstract
Background The potential of insecticide-treated bednets (ITNs) to contribute to child survival has been well documented in randomised controlled trials. ITN coverage has increased rapidly in Kenya from 7% in 2004 to 67% in 2006. We aimed to assess the extent to which this investment has led to improvements in child survival.Methods A dynamic cohort of about 3500 children aged 1-59 months were enumerated three times at yearly intervals in 72 rural clusters located in four districts of Kenya. The effect of ITN use on mortality was assessed with Poisson regression to take account of potential effect-modifying and confounding covariates.Findings 100 children died over 2 years. Overall mortality rates were much the same in the first and second years of the study (14.5 per 1000 person-years in the first year and 15.4 per 1000 person-years in the second). After adjustment for age, time period, and a number of other possible confounding variables, ITN use was associated with a 44% reduction in mortality (mortality rate ratio 0.56, 95% CI 0.33-0.96; p=0.04). This level of protection corresponds to about seven deaths averted for every 1000 ITNs distributed.Interpretation A combined approach of social marketing followed by mass free distribution of ITNs translated into child survival effects that are comparable with those seen in previous randomised controlled trials.
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ITNs have been shown convincingly to cause substantial reductions in all-cause child mortality under both experimental and operational conditions.
“ITNs have been shown convincingly to cause substantial reductions in all-cause child mortality, under both experimental (Lengeler 2004) and operational conditions (Armstrong Schellenberg et al. 2001; Fegan et al. 2007).”
From Global Status of DDT and Its Alternatives for Use in Vector Control to Prevent Disease (2009) · cites this paper as Fegan et al. 2007
The Results report that, under operational conditions in rural Kenya, ITN use was associated with a 44% reduction in child mortality after adjustment. The Discussion says the authors were confident of a substantial effect on child survival, but also acknowledges possible unmeasured confounding and exposure bias. Thus the study supports a substantial operational benefit, not the unqualified claim that it convincingly established causation; the experimental finding is cited to a different source. (LLM, conf=0.83)
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- Authors
- Fegan, G. W., Noor, A. M., Akhwale, W. S., Cousens, S., & Snow, R. W.
- Affiliations
- Kenya Medical Research Institute (KE)
- Ministry of Health (KE)
- London School of Hygiene & Tropical Medicine (GB)
- John Radcliffe Hospital (GB)
- Corresponding author
- Fegan, Greg W
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2007-09
- Volume
- 370
- Issue
- 9592
- Pages
- 1035-1039
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC2117339
- OpenAlex
- W2143229710
- Cited by
- 237
- References
- 17
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 9 · 2019: 5 · 2018: 8 · 2017: 7 · 2016: 7 · 2015: 15 · 2014: 10 · 2013: 18 · 2012: 22
- FWCI
- 31.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- Wellcome Trust (#079081, 058922, 079080, 081829)
- Government of the Republic of Kenya
- Department for International Development
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Keywords
- insecticide-treated bednets, child mortality, child survival, malaria prevention, social marketing, rural Kenya, mortality rate ratio, mortality averted
- MeSH terms
- Adult, Bedding and Linens, Child, Preschool, Female, Humans, Infant, Insecticides, Kenya, Longitudinal Studies, Malaria, Male, Rural Health, Social Class, Poisson Distribution, Child Mortality
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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