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

Carol Gamble; Paul J. Ekwaru; Paul Garner; Feiko O. Ter Kuil

doi:10.1371/journal.pmed.0040107

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

Carol Gamble, Paul J. Ekwaru, Paul Garner, Feiko O. Ter Kuil

Clinical Sciences

Research output: Contribution to journal › Review article › peer-review

151 Citations (Scopus)

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.

Original language	English
Pages (from-to)	506-515
Number of pages	10
Journal	PLoS Medicine
Volume	4
Issue number	3
DOIs	https://doi.org/10.1371/journal.pmed.0040107
Publication status	Published - 27 Mar 2007

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Plos Medicine 4 3 e107Final published version, 553 KBLicence: CC BY

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@article{ff3356de4925425a9b920cc1849a8cc5,

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

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.",

author = "Carol Gamble and Ekwaru, \{Paul J.\} and Paul Garner and \{Ter Kuil\}, \{Feiko O.\}",

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T1 - Insecticide-treated nets for the prevention of malaria in pregnancy: A systematic review of randomised controlled trials

AU - Gamble, Carol

AU - Ekwaru, Paul J.

AU - Garner, Paul

AU - Ter Kuil, Feiko O.

PY - 2007/3/27

Y1 - 2007/3/27

N2 - 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.

AB - 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.

U2 - 10.1371/journal.pmed.0040107

DO - 10.1371/journal.pmed.0040107

M3 - Review article

SN - 1549-1277

VL - 4

SP - 506

EP - 515

JO - PLoS Medicine

JF - PLoS Medicine

IS - 3

ER -

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

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