Utilization of insecticide-treated nets for malaria prevention among children in Africa: a systematic review and meta-analysis

Despite the proven effectiveness of insecticide-treated nets (ITNs) in reducing malaria incidence and mortality, their usage among children in Africa remains inadequate. This systematic review and meta-analysis aimed to ascertain the prevalence of ITN usage for malaria control among children in Africa.

This review was registered with Prospero (CRD42023474978). A search was conducted in Scopus, PubMed, and Google Scholar for publications between 2013 and 2023. The study population was children in Africa, the intervention was ITN utilization, and the prevalence of ITN use was the outcome. The Jonna Briggs Institute (JBI) criteria were used to evaluate the quality of the included studies. A random effects model determined the overall pooled prevalence of ITN utilization. A sub-group analysis was carried out based on regions of Africa. Egger's Regression-based test was used to identify publication bias.

This review included 30 studies with 76,045 children, 50 households, and 1009 caregivers. Among the 30 included studies, 26 (86.7%) determined the ITN utilization in children, three (10%) evaluated the use of ITN by caregivers of children, and one (3.3%) article reported ITN utilization in households with children. In addition, 28 (93.3%) studies were cross-sectional. The pooled prevalence of ITN utilization was 69.50% with a 95% CI (64.5-74.5%). Statistically significant heterogeneity was observed (I² = 100%, p = 0.001). ITN utilization was highest in Central Africa (85.44%, 95% CI 85.3-85.6), followed by Southern Africa (80.7%, 95%CI 80.6-80.9) and Eastern Africa (69.2%, 95%CI 63.8-74.6), and lowest in West Africa (67.0%, 95% CI 56.2-77.8).

The prevalence of ITN utilization among children in Africa is low and varies by region. This utilization needs to be improved.