Impact of Population Services International (PSI) Insecticide-treated Net (ITNs) Distribution on Malaria Prevalence in Pregnancy: A Case of Kimilili-Bungoma Sub-County, Kenya

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Mukhwana Dennis Wafula


Insecticide-treated net (ITN) use is one of the most promising tools which have been shown to reduce the number of mosquito bites. Pregnant women and children less than five years have been specifically designated as high-risk groups, therefore need to be protected by effective personal protection. An intensive effort by Population Services International (PSI) to prevent malaria among vulnerable groups in Kenya by creating a mosquito ‘net culture’ was launched in 2002 sells highly subsidized nets. During the second half of the project (2004-2007) Population service international (PSI) increased its focus on the rural population. Despite these efforts, there is inadequate knowledge about the efficacy of net use in controlling malaria in the high-risk groups in the study area. This research determined the effects of PSI efforts in rural areas by assessing malaria prevalence among the pregnant women attending antenatal clinics at Kimilili Sub-county (Bungoma County, Kenya) Hospital. The study used cross-sectional descriptive survey design. It was conducted between April to October 2017 and November 2017 to March 2018 which correspond to during rainy season and dry seasons respectively. The study recruited a total of 320 pregnant women were involved in the study. This was done before the rolling out of the whole family net coverage in twenty-three endemic counties. The information obtained should act as baseline data in the study area for future assessment of the impact of nationwide mass net distribution by the ministry of public health and sanitation. A structured questionnaire was administered to determine net use and a sample of blood was taken by finger prick method to determine the peripheral malaria parasitemia. Some fewer net users were malaria positive as compared to non-users suggesting that net uses were more protected. The course of malaria infection was noted depend on age and parity. This study demonstrates that net use reduce malaria and it’s associated anaemia in pregnancy. Also, dry seasons should not be perceived as low transmission periods because the results revealed that there was still a very significant transmission. It was also concluded that the multigravidae had developed more immunity as compared to the primi- and secundigravidae. It was recommended that the focus for educational programs should shift from net re-treatment to augmenting adherence. Coverage of entire populations will be required to accomplish large reductions of malaria in endemic areas.

Insecticide-treated net, malaria-endemic region, malaria prevalence, pregnancy, Bungoma Kenya.

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Wafula, M. D. (2020). Impact of Population Services International (PSI) Insecticide-treated Net (ITNs) Distribution on Malaria Prevalence in Pregnancy: A Case of Kimilili-Bungoma Sub-County, Kenya. South Asian Journal of Parasitology, 4(2), 1-8. Retrieved from
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Papaioannou I, Utzinger J, Vounatsou P. Malaria-anemia comorbidity prevalence as a measure of malaria-related deaths in Sub-Saharan Africa. Scientific Reports. 2019;9(1):1-9.

Kwenti TE. Malaria and HIV coinfection in Sub-Saharan Africa: Prevalence, impact, and treatment strategies. Research and Reports in Tropical Medicine. 2018;9(123).

Apouey BH, Picone G, Wilde J, Coleman J, Kibler R. Malaria and anemia among children in Sub-Saharan Africa: The effect of mosquito net distribution. Revue Économique. 2017;68(2):163-197.

Inungu JN, Ankiba N, Minelli M, Mumford V, Bolekela D, Mukoso B, Onema W, Kouton E, Raji D. Use of insecticide-treated mosquito net among pregnant women and guardians of children under five in the Democratic Republic of the Congo. Malaria Research and Treatment; 2017.

Mwanika A. Utilization of insecticide treated nets in households with children under five years of age in Northern Division, Mbale District, Uganda. Kampala International University, College of Economics and Management; 2018.

Okumu FO, Moore SJ. Combining indoor residual spraying and insecticide-treated nets for malaria control in Africa: A review of possible outcomes and an outline of suggestions for the future. Malaria Journal. 2011;10(1):208.

Singh M, Brown G, Rogerson SJ. Ownership and use of insecticide-treated nets during pregnancy in Sub-Saharan Africa: A review. Malaria Journal. 2013;12(1):268.

Wisniewski J, Acosta A, Kolaczinski J, Koenker H, Yukich J. Systematic review and meta-analysis of the cost and cost-effectiveness of distributing insecticide-treated nets for the prevention of malaria. Acta Tropica. 2020;202(105229).

Bradley J, Ogouyèmi-Hounto A, Cornélie S, Fassinou J, de Tove YSS, Adéothy AA, Tokponnon FT, Makoutode P, Adechoubou A, Legba T. Insecticide-treated nets provide protection against malaria to children in an area of insecticide resistance in Southern Benin. Malaria Journal. 2017;16(1):225.

Krezanoski PJ, Comfort AB, Hamer DH. Effect of incentives on insecticide-treated bed net use in Sub-Saharan Africa: A cluster randomized trial in Madagascar. Malaria Journal. 2010;9(1):186.

Zhou G, Li JS, Ototo EN, Atieli HE, Githeko AK, Yan G. Evaluation of universal coverage of insecticide-treated nets in Western Kenya: Field surveys. Malaria Journal. 2014;13(1):351.

Mutulei ACN e. Factors influencing the uptake of intermittent preventive treatment for malaria in pregnancy: Evidence from Bungoma East District, Kenya. Am J Pub Health Res. 2013;1:110-123.

Ndwiga T, Kei RM, Dancan OW. Utilization of insecticide treated bed nets among mothers attending MCH/FP in Webuye District Hospital, Bungoma County, Kenya. Open Journal of Preventive Medicine; 2014.

Kakai RM, Nasimiyu J, Odero W. Low reliability of home-based diagnosis of malaria in a rural community in Western Kenya. The Journal of Infection in Developing Countries. 2011;5(01):054-058.

Chow SC, Wang H, Shao J. Sample size calculations in clinical research. CRC Press; 2007.

Tambo E, Adedeji AA, Huang F, Chen JH, Zhou SS, Tang LH. Scaling up impact of malaria control programmes: A tale of events in Sub-Saharan Africa and People’s Republic of China. Infectious Diseases of Poverty. 2012;1(1):7.

Wiseman V, Scott A, McElroy B, Conteh L, Stevens W. Determinants of bed net use in the Gambia: Implications for malaria control. The American Journal of Tropical Medicine and Hygiene. 2007;76(5):830-836.

Fraser-Hurt N, Felger I, Edoh D, Steiger S, Mashaka M, Masanja H, Smith T, Mbena F, Beck HP. Effect of insecticide-treated bed nets on haemoglobin values, prevalence and multiplicity of infection with Plasmodium falciparum in a randomized controlled trial in Tanzania. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1999;93(Supplement_1):47-51.

Fillinger U, Ndenga B, Githeko A, Lindsay SW. Integrated malaria vector control with microbial larvicides and insecticide-treated nets in Western Kenya: A controlled trial. Bulletin of the World Health Organization. 2009;87:655-665.

Sexton JD. Impregnated bed nets for malaria control: Biological success and social responsibility. The American Journal of Tropical Medicine and Hygiene. 1994;50(6_Suppl):72-81.

Larson PS, Minakawa N, Dida GO, Njenga SM, Ionides EL, Wilson ML. Insecticide-treated net use before and after mass distribution in a fishing community along Lake Victoria, Kenya: Successes and unavoidable pitfalls. Malaria Journal. 2014;13(1):466.

Pulford J, Hetzel MW, Bryant M, Siba PM, Mueller I. Reported reasons for not using a mosquito net when one is available: A review of the published literature. Malaria Journal. 2011;10(1):83.

Koenker H, Yukich JO. Effect of user preferences on ITN use: A review of literature and data. Malaria Journal. 2017;16:233