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

Gamble, Carol; Ekwaru, Paul J.; Garner, Paul and ter Kuile, Feiko O. (2007) Insecticide-treated nets for the prevention of malaria in pregnancy: a systematic review of randomised controlled trials. PLoS Medicine, 4 (3). Article Number: e107. 0506-0515. ISSN 1549-1277

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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:Published: March 27, 2007. Citation: Gamble C, Ekwaru PJ, Garner P, ter Kuile FO (2007) Insecticide-Treated Nets for the Prevention of Malaria in Pregnancy: A Systematic Review of Randomised Controlled Trials. PLoS Med 4(3): e107 doi:10.1371/journal.pmed.0040107
Uncontrolled Keywords:SUB-SAHARAN AFRICA; BED NETS; WESTERN KENYA; INFANT-MORTALITY; CHILD-MORTALITY; ANEMIA; BEDNETS; INSECTICIDES; BIRTH-WEIGHT
Subjects:R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments, Research Centres and Related Units:Academic Faculties, Institutes and Research Centres > Research Centres > Medical Statistics and Health Evaluation, Centre for
DOI:10.1371/journal.pmed.0040107
Publisher's Statement:Copyright: © 2007 Gamble et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For further information please click on link at related URL Field.
Related URLs:
Refereed:Yes
Status:Published
ID Code:305
Deposited On:27 Nov 2007 15:52
Last Modified:05 Mar 2012 15:46

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