Insecticide-treated nets for the prevention of malaria in pregnancy: A systematic review of randomised controlled trials

Gamble, C., Ekwaru, P. J., Garner, Paul ORCID: https://orcid.org/0000-0002-0607-6941 and terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617 (2007) 'Insecticide-treated nets for the prevention of malaria in pregnancy: A systematic review of randomised controlled trials'. PLoS Medicine, Vol 4, Issue 3, e107.

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Abstract

Background

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.

Methods and Findings

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.

Conclusions

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.

Item Type:	Article
Additional Information:	The electronic version is the original and can be found at: http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040107
Subjects:	QX Parasitology > Insects. Other Parasites > QX 600 Insect control. Tick control WC Communicable Diseases > Tropical and Parasitic Diseases > WC 765 Prevention and control WQ Obstetrics > Pregnancy Complications > WQ 256 Infectious diseases
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pmed.0040107
Depositing User:	Ms Julia Martin
Date Deposited:	04 Sep 2012 07:57
Last Modified:	06 Sep 2019 10:14
URI:	https://archive.lstmed.ac.uk/id/eprint/1195

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