Abstract
Long-lasting insecticidal nets (LLINs) have been widely used as an effective alternative to conventional insecticide-treated nets (ITNs) for over a decade. Due to the growing number of field trials and interventions reporting the effectiveness of LLINs in controlling malaria, there is a need to systematically review the literature on LLINs and ITNs to examine the relative effectiveness and characteristics of both insecticide nettings. A systematic review of over 2000 scholarly articles published since the year 2000 was conducted. The odds ratios (ORs) of insecticidal net effectiveness in reducing malaria were recorded. The final dataset included 26 articles for meta-regression analysis, with a sample size of 154 subgroup observations. While there is substantial heterogeneity in study characteristics and effect size, we found that the overall OR for reducing malaria by LLIN use was 0.44 (95% CI = 0.41–0.48, p < 0.01) indicating a risk reduction of 56%, while ITNs were slightly less effective with an OR of 0.59 (95% CI = 0.57–0.61, p <0.01). A meta-regression model confirms that LLINs are significantly more effective than ITNs in the prevention of malaria, when controlling for other covariates. For both types of nets, protective efficacy was greater in high transmission areas when nets were used for an extended period. However, cross-sectional studies may overestimate the effect of the nets. The results surprisingly suggest that nets are less effective in protecting children under the age of five, which may be due to differences in child behavior or inadequate coverage. Compared to a previous meta-analysis, insecticide-treated nets appear to have improved their efficacy despite the risks of insecticide resistance. These findings have practical implications for policymakers seeking effective malaria control strategies.
Highlights
With approximately 200 million cases per year, malaria is responsible for a large proportion of the global burden of disease and is a serious public health issue in Africa [1]
Of the 14 insecticide-treated nets (ITNs) articles, six were randomized controlled trials [3,5,7,27,28,29], six were crossstudies [2,25,26,30,31,32] that compared malaria prevalence between a group that slept under ITNs and sectional studies [2,25,26,30,31,32] that compared malaria prevalence between a group that slept under a group that did not and two were cohort studies [33,34] that analyzed malaria rates within groups
Twelve articles addressed malaria caused by P. falciparum or before and after using an ITN
Summary
With approximately 200 million cases per year, malaria is responsible for a large proportion of the global burden of disease and is a serious public health issue in Africa [1]. The fight against malaria has forged an extensive global public health initiative. Policymakers consider insecticide-treated nets (ITNs) one of the most successful vector control tools to combat malaria. Mosquito nets treated with synthetic pyrethroid insecticides have been shown to cause a decline in malaria morbidity and mortality in field efficacy trials carried out in different countries [2,3,4,5]. Over 427 million nets were delivered to households in Sub-Saharan Africa between 2012 and 2014 [1]. Res. Public Health 2018, 15, 546; doi:10.3390/ijerph15030546 www.mdpi.com/journal/ijerph
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