Insecticide-treated bed nets and curtains for preventing malaria
Editorial Group: Cochrane Infectious Diseases Group
Published Online: 19 APR 2004
Assessed as up-to-date: 18 JAN 2004
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Lengeler C. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD000363. DOI: 10.1002/14651858.CD000363.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 19 APR 2004
Malaria is an important cause of illness and death in many parts of the world, especially in sub-Saharan Africa. There has been a renewed emphasis on preventive measures at community and individual levels. Insecticide-treated nets (ITNs) are the most prominent malaria preventive measure for large-scale deployment in highly endemic areas.
To assess the impact of insecticide-treated bed nets or curtains on mortality, malarial illness (life-threatening and mild), malaria parasitaemia, anaemia, and spleen rates.
I searched the Cochrane Infectious Diseases Group trials register (January 2003), CENTRAL (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to October 2003), EMBASE (1974 to November 2002), LILACS (1982 to January 2003), and reference lists of reviews, books, and trials. I handsearched journals, contacted researchers, funding agencies, and net and insecticide manufacturers.
Individual and cluster randomized controlled trials of insecticide-treated bed nets or curtains compared to nets without insecticide or no nets. Trials including only pregnant women were excluded.
Data collection and analysis
The reviewer and two independent assessors reviewed trials for inclusion. The reviewer assessed the risk of bias in the trials, and extracted and analysed data.
Fourteen cluster randomized and eight individually randomized controlled trials met the inclusion criteria. Five trials measured child mortality: ITNs provided 17% protective efficacy (PE) compared to no nets (relative rate 0.83, 95% confidence interval (CI) 0.76 to 0.90), and 23% PE compared to untreated nets (relative rate 0.77, 95% CI 0.63 to 0.95). About 5.5 lives (95% CI 3.39 to 7.67) can be saved each year for every 1000 children protected with ITNs. In areas with stable malaria, ITNs reduced the incidence of uncomplicated malarial episodes in areas of stable malaria by 50% compared to no nets, and 39% compared to untreated nets; and in areas of unstable malaria: by 62% for compared to no nets and 43% compared to untreated nets for Plasmodium falciparum episodes, and by 52% compared to no nets and 11% compared to untreated nets for P. vivax episodes. When compared to no nets and in areas of stable malaria, ITNs also had an impact on severe malaria (45% PE, 95% CI 20 to 63), parasite prevalence (13% PE), high parasitaemia (29% PE), splenomegaly (30% PE), and their use improved the average haemoglobin level in children by 1.7% packed cell volume.
ITNs are highly effective in reducing childhood mortality and morbidity from malaria. Widespread access to ITNs is currently being advocated by Roll Back Malaria, but universal deployment will require major financial, technical, and operational inputs.
Plain language summary
Insecticide-treated nets can reduce deaths in children by one fifth and episodes of malaria by half.
Sleeping under mosquito nets treated with insecticide aims to prevent malaria in areas where the infection is common. They are widely promoted by international agencies and governments to reduce the bad effects of malaria on health. This review showed that good quality studies of impregnated nets markedly reduce child deaths and illnesses from malaria.
作者搜尋Cochrane Infectious Diseases Group trials register (2003年1月)、CENTRAL (Cochrane Library, Issue 1, 2003)、 MEDLINE (1966年−2003年10月)、EMBASE (1974年−2002年11月)、LILACS (1982年−2003年1月)、及文獻回顧、書籍、還有試驗的參考文獻清單。作者並且人工搜尋期刊，與研究人員、贊助機構以及網子及殺蟲藥的廠商聯繫。
共有14項聚類隨機試驗及8項個體隨機對照試驗符合收錄標準。其中5項試驗測量了兒童之死亡率：相較於無蚊帳者，ITNs可提供17%之保護效力(protective efficacy；PE) (相對率0.83, 95%信賴區間(confidence interval；CI) 0.76 – 0.90)，而相較於未經殺蟲劑處理蚊帳，其可提供23% PE (相對率0.77, 95% CI 0.63 – 0.95)。就每1000名經ITNs保護之兒童而言，此種措施每年可拯救約5.5人(95% CI 3.39 – 7.67)。在具有穩定瘧疾風險之區域：ITNs相較於無蚊帳可減少50%之非重症瘧疾發生，相較於未經殺蟲劑處理蚊帳可減少39%；而在具有不穩定瘧疾風險之區域：ITNs相較於無蚊帳可減少62%之惡性瘧疾發生，相較於未經殺蟲劑處理蚊帳可減少43%；且ITNs相較於無蚊帳可減少52%之間日瘧發生，相較於未經殺蟲劑處理蚊帳可減少11%。當在具有穩定瘧疾風險之區域與無蚊帳比較時，ITNs亦可影響嚴重瘧疾(45% PE, 95% CI 20 – 63)、寄生蟲盛行率(13% PE)、高寄生蟲血症(29% PE)、脾腫大(30% PE)，且其使用可對兒童之平均血紅素量造成1.7%血細胞壓積之改善。
ITNs可高度有效的降低瘧疾之兒童死亡率及發病率。Roll Back Malaria計畫目前主張應廣泛使用ITNs，但是其全球性之使用將需要投入大量之財力、技術、及操作。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。