Spatial distribution of bednet coverage under routine distribution through the public health sector in a rural district in Kenya.

Insecticide-treated nets (ITNs) are one of the most important and cost-effective tools for malaria control. Maximizing individual and community benefit from ITNs requires high population-based coverage. Several mechanisms are used to distribute ITNs, including health facility-based targeted distribution to high-risk groups; community-based mass distribution; social marketing with or without private sector subsidies; and integrating ITN delivery with other public health interventions. The objective of this analysis is to describe bednet coverage in a district in western Kenya where the primary mechanism for distribution is to pregnant women and infants who attend antenatal and immunization clinics. We use data from a population-based census to examine the extent of, and factors correlated with, ownership of bednets. We use both multivariable logistic regression and spatial techniques to explore the relationship between household bednet ownership and sociodemographic and geographic variables. We show that only 21% of households own any bednets, far lower than the national average, and that ownership is not significantly higher amongst pregnant women attending antenatal clinic. We also show that coverage is spatially heterogeneous with less than 2% of the population residing in zones with adequate coverage to experience indirect effects of ITN protection.

Reduction of malaria prevalence by indoor residual spraying: a meta-regression analysis.

Indoor residual spraying (IRS) has become an increasingly popular method of insecticide use for malaria control, and many recent studies have reported on its effectiveness in reducing malaria burden in a single community or region. There is a need for systematic review and integration of the published literature on IRS and the contextual determining factors of its success in controlling malaria. This study reports the findings of a meta-regression analysis based on 13 published studies, which were chosen from more than 400 articles through a systematic search and selection process. The summary relative risk for reducing malaria prevalence was 0.38 (95% confidence interval = 0.31-0.46), which indicated a risk reduction of 62%. However, an excessive degree of heterogeneity was found between the studies. The meta-regression analysis indicates that IRS is more effective with high initial prevalence, multiple rounds of spraying, use of DDT, and in regions with a combination of Plasmodium falciparum and P. vivax malaria.

Using decision analysis to improve malaria control policy making.

Malaria and other vector-borne diseases represent a significant and growing burden in many tropical countries. Successfully addressing these threats will require policies that expand access to and use of existing control methods, such as insecticide-treated bed nets (ITNs) and artemesinin combination therapies (ACTs) for malaria, while weighing the costs and benefits of alternative approaches over time. This paper argues that decision analysis provides a valuable framework for formulating such policies and combating the emergence and re-emergence of malaria and other diseases. We outline five challenges that policy makers and practitioners face in the struggle against malaria, and demonstrate how decision analysis can help to address and overcome these challenges. A prototype decision analysis framework for malaria control in Tanzania is presented, highlighting the key components that a decision support tool should include. Developing and applying such a framework can promote stronger and more effective linkages between research and policy, ultimately helping to reduce the burden of malaria and other vector-borne diseases.

The Use of Agricultural Chemicals and Mosquito Response to Pyrethroids in Bungoma Sub-county,Western Kenya

Insecticide treated bed nets and indoor residual spraying are the most widely used vector control methods in Africa. The World Health Organization now recommends four classes of insecticides for use against adult mosquitoes in public health programs. Of these four classes of insecticides, pyrethroids have become the insecticides of choice in treating mosquito bed nets and in the use of indoor spraying to prevent malaria transmission. Pyrethroids are not only used in malaria control but also in agriculture to protect against pest insects. This concurrent use of pyrethroids in vector control and protection of crops from pests in agriculture may exert selection pressure on mosquito larval population and induce resistance to this class of insecticides. The main objective of our study was to explore the role of agricultural chemicals and the response of mosquitoes to pyrethroids in an area of high malaria transmission.

We used a cross-sectional study design. This was a two-step study involving both mosquitoes and human subjects. In this study, we collected larvae growing in breeding sites affected by different agricultural practices. We used purposive sampling to identify active mosquito breeding sites and then interviewed households adjacent to those breeding sites to learn about their agricultural practices that might influence the response of mosquitoes to pyrethroids. We also performed secondary analysis of larval data from a previous case-control study by Obala et al.