ITNs (insecticide-treated bednets) can bring child mortality down by 44%. An approach that includes social marketing and free ITN distribution leads to a significant child survival boost, according to an article appearing in The Lancet, this week's issue.

In Kenya ITN coverage was 7% in 2004, by the end of 2006 it reached 67%.

Dr Greg Fegan, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya and team monitored 3,500 children, all under five years of age, for a period of three years. They all lived in four districts of Kenya, in 72 rural clusters. The researchers discovered that child mortality rates for those who used a recently treated bednet were 44% lower than those who did not.

"Using these estimates of protection, we estimate that the scaling-up of ITN coverage might have averted seven deaths for every 1000 ITNs used. However, there is considerable mortality variation by area - the effects were greatest in areas of reported high malaria transmission," the authors explained.

The researchers are fairly sure that the significant effect on child survival took place during the expansion phase of the ITN strategy, which may have cut by one third the total number of childhood deaths in areas with high coverage in 2006. "Donor agencies should regard this as money well spent and recognize that the challenge is now to maintain and increase funding to expand coverage further," they wrote.

"With this work, the use of insecticide-treated bednets is confirmed as a major child-survival intervention in malaria-endemic settings in sub-Saharan Africa. The ongoing switch to long-lasting insecticidal bednets will further reinforce this intervention," Professors Christian Lengeler and Don deSavigny, Swiss Tropical Institute, Basel, Switzerland, wrote in an accompanying Comment.

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