INSECTICIDE-TREATED BEDNETS REDUCE MORTALITY AND SEVERE MORBIDITY FROM MALARIA AMONG CHILDREN ON THE KENYAN COAST

New tools to prevent malaria morbidity and mortality are needed to imp rove child survival in sub-Saharan Africa. Insecticide treated bednets (ITBN) have been shown, in one setting (The Gambia, West Africa), to reduce childhood mortality. To assess the impact of ITBN on child surv ival under different epidemiological and cultural conditions we conduc ted a community randomized, controlled trial of permethrin treated bed nets (0.5 g/m(2)) among a rural population on the Kenyan Coast. Betwee n 1991 and 1993 continuous community-based demographic surveillance li nked to hospital-based in-patient surveillance identified all mortalit y and severe malaria morbidity events during a 2-year period among a p opulation of over 11 000 children under 5 years of age. In July 1993, 28 randomly selected communities were issued ITBN, instructed in their use and the nets re-impregnated every 6 months. The remaining 28 comm unities served as contemporaneous controls for the following 2 years, during which continuous demographic and hospital surveillance was main tained until the end of July 1995. The introduction of ITBN led to sig nificant reductions in childhood mortality (PE 33%, CI 7-51%) and seve re, life-threatening malaria among children aged 1-59 months (PE 44%, CI 19-62). These findings confirm the value of ITBN in improving child survival and provide the first evidence of their specific role in red ucing severe morbidity from malaria.