Insecticide-treated bednets and curtains for preventing malaria

Area of Science:

• Public Health
• Infectious Diseases
• Preventive Medicine

Background:

• Malaria remains a major global health burden, particularly in Africa, necessitating effective preventive strategies.
• Insecticide-treated bednets (ITNs) and curtains are recognized as a key preventive measure against malaria.
• There is a renewed focus on community and individual-level malaria prevention methods.

Purpose of the Study:

• To systematically evaluate the efficacy of insecticide-treated bednets or curtains in preventing malaria.
• To assess the impact of ITNs on malaria-related mortality and morbidity.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (Cochrane, Medline, Embase) and through hand-searching and direct contact with researchers and manufacturers.
• Included were randomized and quasi-randomized trials comparing insecticide-treated nets/curtains with untreated nets or no nets.
• Studies involving pregnant women were excluded; trial quality was assessed, and data were extracted and reviewed by independent individuals.

Main Results:

• Out of 65 identified studies, 18 were included in the review, with 11 employing cluster randomization.
• Insecticide-treated nets showed a protective efficacy of 17% against childhood mortality (relative risk 0.83 compared to plain/no nets).
• ITNs reduced child mortality by 23% (relative risk 0.77 vs. untreated nets), potentially saving six lives per 1000 children protected annually. Incidence of mild malaria episodes decreased by 48% (vs. no nets) and 34% (vs. untreated nets).

Conclusions:

• Insecticide-treated nets are demonstrably effective in reducing both mortality and morbidity associated with childhood malaria.
• Achieving widespread access to ITNs necessitates substantial financial, technical, and operational investments.
• The findings support the continued promotion and implementation of ITNs as a critical malaria control tool.