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Abstract. The objective of this study is to determine the effect of permethrin insecticide-treated bed net (PITN) use on the incidence of febrile episodes and on household malaria expenses in Benin. Over the course of one year, 208 randomly selected PITN user and non-user households were visited weekly to determine expenditures on febrile morbidity and its treatment, and to monitor spending on malaria prevention. Multivariate analyses were performed to distinguish the effects of PITN use from other important determinants of morbidity, such as malaria-related beliefs and practices, income, and other socio-economic variables. Results from the logistic regression analysis show that the use of PITNs decreases the risk of febrile episodes by 34% in children living in the rural zone. Multiple regression analysis reveals that PITN use does not reduce prevention and treatment expenses. These expenses are significantly associated with women's income. This report also discusses other factors associated with febrile morbidity and malaria-related expenditures.The results of a study performed to promote the use of permethrin insecticide-treated bed nets (PITNs) in a hyperendemic malaria region of Benin show that children living in rural areas have approximately two febrile episodes per year. Caregivers spend an average of US$1.62 for each febrile episode and a total of US$2.52 for treatment of the illness. 1 Chemoprophylaxis expenditures are substantial and are equivalent to roughly half of what it has been observed that the rural populations spends for treatment. However, even though medication is purchased, irregular use of chemoprophylaxis limits its effect.The literature suggests certain hypotheses to explain the factors that affect the number of febrile episodes and malaria prevention spending. For example, it is well known that the frequency of febrile episodes caused by malaria decreases as an individual grows older. In effect, the repeated infections over time aid the natural immunity of an individual to confer some resistance to malaria parasites. 2 This was expected in the present study, since data from the malariometric survey in the study area in 1993 showed significantly lower splenic indices in the higher age group (5-9 years old) than in the lower one (2 to Ͻ5 years old): 56.9% and 76.2% respectively (P Ͻ 0.001) (Rashed S, 1993 unpublished data). Spending tends to vary with occupation, level of income and education. 3 Prevention and treatment attitudes and practices may also explain variation in spending, as may physical factors such as distance between a village and the nearest hospital. 4,5 The objective of this study is to determine what effect PITN use has on other known factors: 1) the frequency of febrile episodes, 2) treatment expenses, and 3) household expenditures for malaria prevention. Since many factors may influence these expenditures and morbidity, a multivariate analysis was used to distinguish the effect of PITN use from other factors. METHODOLOGYStudy area. The study area is situated 250 km no...

Through a Benin-Canada participatory research initiative which included both Benin and Canadian non-governmental organizations, a local capacity to produce and market bednets for the prevention of malaria was developed. The development process began following a community-based assessment of local needs and skills. All materials for the manufacture and distribution of the bednets were obtained locally with the exception of the netting which was imported from Canada. The sustainability of the enterprise is enhanced by the community's recognition of the importance of malaria and the culturally acceptable practice of bednet use.

Abstract. In preparation for a study on the effect of bed net use on malaria, this article describes febrile morbidity and malaria expenditures in a sub-Saharan area (Benin) of hyperendemic malaria. The 325 randomly selected households were visited weekly between April 1994 and March 1995 to determine febrile morbidity and household expenditures for prevention and treatment. The results indicate that rural children had two febrile episodes annually compared with 0.3 episodes among children living in the city. There was no difference in mean annual febrile episodes between adults and children (adults ϭ 1.5, children ϭ 1.5; P ϭ 0.48) and in the expenditures per febrile episode (adults ϭ US$1.85, children ϭ US$1.62; P ϭ 0.45). Annual prevention expenditures were higher for adults than for children (US$1.73 and US$1.28, respectively; P Ͻ 0.001), although there was no significant difference in expenditures for annual treatment for adults and children (US$2.15 and US$2.34, respectively). These and other findings are analyzed further and discussed.In addition to being a major cause of mortality and morbidity in developing countries, malaria also has economic consequences for the afflicted population. These consequences include considerable direct (medical consultations, hospitalizations, laboratory tests, and medications) and indirect (work days lost) costs for households that are already socioeconomically disadvantaged. 1-4 Chloroquine chemoprophylaxis, mosquito coils, insecticide sprays and bed nets are the principal malaria prevention methods used. The permethrin insecticide-treated bed net (PITN), in particular, can reduce mortality and malaria morbidity by 30-45%. [5][6][7] There is considerable variation in the price of a PITN, an item with an approximate lifespan of five years. Although in theory, it may cost US$6-7, 5,6 in reality its price is closer to US$12, taking into account size, local duties, transportation, taxes, and other costs. Studies have shown that a PITN treated with a permethrin concentration of 200-500mg/m 2 works effectively for a six-month period, after which a new permethrin treatment is necessary. 5 The cost of each treatment is estimated at US$1.43, for an average annual use cost of US$7.79, as estimated by Brinkmann and Brinkmann.8 By decreasing the malaria attack episodes, the use of the PITN also reduces the expenses associated with the illness. Therefore, over time, the cost of the initial investment in the PITN is many times less than the treatment expenses. In effect, the cost of the PITN is amortized in only two years following its acquisition, a phenomenon that is often accompanied as well by a reduction in spending on chloroquine treatment and prophylaxis, insecticide sprays, and mosquito coils. [8][9][10][11][12] This article describes a continuous analysis of the PITN that is locally produced and used in a operational research setting in the Republic of Benin in west Africa. 13 This article (the first in a two-part series) presents the study methodology, the collection and analy...

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