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CHERG - Child Epidemiology Reference Group
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Insecticide-treatment Mosquito Nets (ITNs), Indoor-residual Spraying (IRS), and Intermittent Preventive Therapy in Pregnant Women (IPTp)

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More Intervention Effect Estimate Summaries

Reference
Eisele TP, Larsen D, Steketee RW. Protective efficacy of interventions for preventing malaria mortality in children in Plasmodium falciparum endemic areas. Int J Epidemiol. 2010 Apr; 39 (Suppl 1): i88-i101.

Background

  • Malaria in sub-Saharan Africa was estimated to have caused over 800,000 deaths in 2000. (1)
  • ITNs and IRS are recommended strategies for preventing malaria in children with their impact on all-cause child mortality (AACM) well demonstrated (2-6), but impact on reducing deaths due to malaria in children has not been well quantified.

Intervention Effects

Insecticide-treated Mosquito Nets (ITNs) on Malaria-attributable Mortality

  • 55% (95% CI: 49-60%) reduction in malaria-attributable mortality among children 1-59 months in Plasmodium falciparum endemic settings. [Moderate Data Quality – based on meta-analyses]:
    • 18% (RR=0.82; 95% CI: 0.75-0.90) protective efficacy (PE) of ITNs for reducing ACCM
    • 51% (RR=0.49; 95% CI: 0.44-0.54) PE of ITNs for reducing uncomplicated malaria
    • 17% (RR=0.83; 95% CI: 0.64-0.88) PE of ITNs for reducing malaria parasite infection prevalence in children

Indoor-residual Spraying (IRS) on Malaria-attributable Mortality

  • Based on the fact that IRS impact on malaria morbidity has been shown to be similar to that of ITNs, it is assumed the impact of IRS I equal to that of ITNs on reducing malaria-attributable mortality in children.

Intermittent Preventive Therapy in Pregnant Women (IPTp) and ITNs in Pregnancy on Low Birth Weight (LBW) among First or Second Pregnancies

  • IPTp is the administration of two or more treatment doses of an effective antimalarial drug (in this case sulphadoxine-pyrimethamine (SP) given at defined intervals during pregnancy of at least 1 month, regardless of parasitic infection at time of treatment.
  • 35% (95% CI: 23-45%) reduction in the prevalence of low birth weight (LBW) in the first or second pregnancy in areas of stable P. falciparum transmission with either IPTp or ITNs.
  • High quality of data (5 high-quality randomized controlled trials – 3 for IPTp and 2 for ITNs)

Intervention Recommendation

  • These data support the continued scale-up of these malaria prevention interventions in endemic settings.

References from Eisele Paper Cited Here

  1. Rowe AK, Samantha YR, Robert WS, et al. The burden of malaria mortality among African children in the year 2000. Int J Epidemiol. 2006; 35:691–704.
  2. Lengeler C. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database Syst Rev. 2004;:CD000363.
  3. Bradley D. Morbidity and mortality at Pare-Taveta, Kenya and Tanzania, 1954-66: the effects of a period of malaria control. In: Feachem R, Jamison D, editors. Disease and Mortality in sub-Saharan Africa. New York: University Oxford Press; 1991. pp. 248–63.
  4. Molineaux L, Gramiccia G. The Garki Project: Research on the Epidemiology and Control of Malaria in the Sudan Savanna of West Africa. Geneva: World Health Organization; 1980. 
  5. Pringle G. Malaria in the Pare area of Tanzania. 3. The course of malaria transmission since the suspension of an experimental programme of residual insecticide spraying. Trans R Soc Trop Med Hyg. 1967;61:69–79.
  6. Payne D, Grab B, Fontaine RE, Hempel JH. Impact of control measures on malaria transmission and general mortality. Bull World Health Organ. 1976;54:369–77.

Examination of Child in Benin

PowerPoint Presentation
Global Child Mortality: Estimates of Levels and Causes for 2000-2010

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