Maintenance and sustained use of insecticide-treated bednets and curtains three years after a controlled trial in western Kenya

In large experimental trials throughout Africa, insecticide-treated bednets and curtains have reduced child mortality in malaria-endemic communities b y 15%-30%. While few questions remain about the efficacy of this interventi on, operational issues around how to implement and sustain insecticide-trea ted materials (ITM) projects need attention. We revisited the site of a sma ll-scale ITM intervention trial, 3 years after the project ended, to assess how local attitudes and practices had changed. Qualitative and quantitativ e methods, including 16 focus group discussions and a household survey (n = 60), were employed to assess use, maintenance, retreatment and perceptions of ITM and the insecticide in former study communities. Families that had been issued bednets were more likely to have kept and maintained them and v alued bednets more highly than those who had been issued curtains. While mo st households retained their original bednets, none had treated them with i nsecticide since the intervention trial was completed 3 years earlier. Most of those who had been issued bednets repaired them, but none acquired new or replacement nets. In contrast, households that had been issued insectici de-treated curtains often removed them. Three (15%) of the households issue d curtains had purchased one or more bednets since the study ended. In hous eholds where bednets had been issued, children 10 years of age and younger were a third as likely to sleep under a net as were adults (relative risk ( RR) = 0.32; 95% confidence interval (95%CI) = 0.19, 0.53). Understanding ho w and why optimal ITM use declined following this small-scale intervention trial can suggest measures that may improve the sustainability of current a nd future ITM efforts.