Insecticide-Treated Nets for the Prevention of Malaria in Pregnancy: A Systematic Review of Randomised Controlled Trials

University of Liverpool, Liverpool, England, United Kingdom
PLoS Medicine (Impact Factor: 14). 04/2007; 4(3):e107. DOI: 10.1371/journal.pmed.0040107
Source: PubMed

ABSTRACT Protection from malaria with insecticide-treated bednets (ITNs) during pregnancy is widely advocated, but evidence of benefit has been inconsistent. We undertook a systematic review of randomised trials.
Three cluster-randomised and two individually randomised trials met the inclusion criteria; four from Africa (n = 6,418) and one from Thailand (n = 223). In Africa, ITNs compared to no nets increased mean birth weight by 55 g (95% confidence interval [CI] 21-88), reduced low birth weight by 23% (relative risk [RR] 0.77, 95% CI 0.61-0.98), and reduced miscarriages/stillbirths by 33% (RR 0.67, 0.47-0.97) in the first few pregnancies. Placental parasitaemia was reduced by 23% in all gravidae (RR 0.77, 0.66-0.90). The effects were apparent in the cluster-randomised trials and the one individually randomised trial in Africa. The trial in Thailand, which randomised individuals to ITNs or untreated nets, showed reductions in anaemia and fetal loss in all gravidae, but not reductions in clinical malaria or low birth weight.
ITNs used throughout pregnancy or from mid-pregnancy onwards have a beneficial impact on pregnancy outcome in malaria-endemic Africa in the first few pregnancies. The potential impact of ITNs in pregnant women and their newborns in malaria regions outside Africa requires further research.

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Available from: Feiko O Ter Kuile, Sep 01, 2015
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    • "alth issue in Tanzania that needs to be addressed by effective preventive measures . Self - reporting of ITNs use by 95% of pregnant women is encouraging considering the reported ITNs efficacy of 23% against placental parasitaemia , 33% against miscar - riage / stillbirth and 23% against LBW according to a systematic reviews of randomised trials ( Gamble et al . 2007 ) . The possibility of overestimating ITNs use in the present study cannot be excluded due to self - reporting as the participant may try to please the interviewer . In the present study , all women with placental malaria reported to have used ITNs , which precludes any effectiveness cal - culation . Our assessment of IPTp effectiveness"
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    ABSTRACT: To assess the effectiveness of IPTp in two areas with different malaria transmission intensities.
    Tropical Medicine & International Health 06/2014; 19(9). DOI:10.1111/tmi.12349 · 2.30 Impact Factor
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    • "Long-lasting, insecticide-treated bed nets (LLINs) are an important public health strategy for malaria prevention adopted by most countries with endemic malaria. In addition to serving as physical barriers between mosquito vectors and individual users, toxicity and repellency induced by the pyrethroid insecticide-impregnated in LLINs can have important community-wide effects on vector density [1-3], and LLINs have been shown to reduce the burden of malaria, especially among children <five years and pregnant women [4,5] who are most vulnerable to malaria. LLINs are also one of the most cost-effective interventions, particularly in areas of high-malaria transmission [6]. "
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    ABSTRACT: Universal coverage of long-lasting insecticide-treated bed nets (LLINs) for prevention of malaria was adopted by the Uganda National Malaria Control Programme in 2007. The first mass distribution of LLINs was implemented in 2010. Initially, a campaign targeted to households with pregnant women and children aged <five years was carried out, prior to a planned fill-in campaign to achieve universal LLIN coverage. This survey was conducted after the targeted distribution in central Uganda to assess progress in LLIN ownership and usage among children <five years.
    Malaria Journal 05/2014; 13(1):185. DOI:10.1186/1475-2875-13-185 · 3.49 Impact Factor
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    • "Pregnant women, infants, and young children are particularly vulnerable to malaria [10,11]. Studies in sub-Saharan Africa have found that ITN use contributes to significant reductions in placental malaria, low birth weight, and still-births, as well as reduced morbidity and mortality among children under five [12,13]. Continuing net shortages make it critical to understand how households allocate nets among their members and whether the most biologically vulnerable groups are protected. "
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    ABSTRACT: Background Access to insecticide-treated bed nets has increased substantially in recent years, but ownership and use remain well below 100% in many malaria endemic areas. Understanding decision-making around net allocation in households with too few nets is essential to ensuring protection of the most vulnerable. This study explores household net allocation preferences and practices across four districts in Uganda. Methods Data collection consisted of eight focus group discussions, twelve in-depth interviews, and a structured questionnaire to inventory 107 sleeping spaces in 28 households. Results In focus group discussions and in-depth interviews, participants almost unanimously stated that pregnant women, infants, and young children should be prioritized when allocating nets. However, sleeping space surveys reveal that heads of household sometimes receive priority over children less than five years of age when households have too few nets to cover all members. Conclusions When asked directly, most net owners highlight the importance of allocating nets to the most biologically vulnerable household members. This is consistent with malaria behaviour change and health education messages. In actual allocation, however, factors other than biological vulnerability may influence who does and does not receive a net.
    Malaria Journal 05/2014; 13(1):183. DOI:10.1186/1475-2875-13-183 · 3.49 Impact Factor
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