Comment in: Trop Med Int Health. 1996 Apr;1(2):137-8.
Impact of permethrin impregnated
bednets on child mortality in Kassena-Nankana district, Ghana: a randomized
controlled trial.
Binka FN, Kubaje A, Adjuik M, Williams LA, Lengeler C, Maude
GH, Armah GE, Kajihara B, Adiamah JH, Smith PG.
Navrongo Health Research Centre, Ministry of Health, Ghana.
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.
PMID: 8665378