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Meta-Analysis
. 2010 Apr;39 Suppl 1(Suppl 1):i88-101.
doi: 10.1093/ije/dyq026.

Protective efficacy of interventions for preventing malaria mortality in children in Plasmodium falciparum endemic areas

Thomas P Eisele  1 , David Larsen, Richard W Steketee
Affiliations
Meta-Analysis

Protective efficacy of interventions for preventing malaria mortality in children in Plasmodium falciparum endemic areas

Thomas P Eisele et al. Int J Epidemiol. 2010 Apr.

Abstract

Background: Insecticide-treated mosquito nets (ITNs) and indoor-residual spraying (IRS) are recommended strategies for preventing malaria in children. While their impact on all-cause child mortality is well documented, their impact on reducing malaria-attributable mortality has not been quantified. While the impact of intermittent preventive therapy in pregnant women (IPTp) and ITNs in pregnancy for improving birth outcomes is also well established, their impact on preventing neonatal or child mortality has not been quantified.

Methods: We performed two systematic literature reviews in Plasmodium falciparum endemic settings; one to estimate the effect of ITNs and IRS on preventing malaria-attributable mortality in children 1-59 months, and another to estimate the effect of ITNs and IPTp on preventing neonatal and child mortality through improvements in birth outcomes.

Results: We estimate the protective efficacy (PE) of ITNs and IRS on reducing malaria-attributable mortality 1-59 months to be 55%, with a range of 49-61%, in P. falciparum settings. We estimate malaria prevention interventions in pregnancy (IPTp and ITNs) to have a pooled PE of 35% (95% confidence interval: 23-45%) on reducing the prevalence of low birth weight (LBW) in the first or second pregnancy in areas of stable P. falciparum transmission.

Conclusion: This systematic review quantifies the PE of ITNs for reducing malaria-attributable mortality in children, and the PE of IPTp and ITNs during pregnancy for reducing LBW. It is assumed the impact of IRS is equal to that of ITNs on reducing malaria-attributable mortality in children. These data will be used in the Lives Saved Tool (LiST) model for estimating the impact of malaria prevention interventions. These data support the continued scale-up of these malaria prevention interventions in endemic settings that will prevent a considerable number of child deaths due directly and indirectly to malaria.

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Figures

Figure 1
Figure 1
Results of systematic review on the effect of ITNs on child health outcomes
Figure 2
Figure 2
Forest plot for the meta-analysis of the effect of ITNs on reducing ACCM
Figure 3
Figure 3
Results of systematic review on the effect of IRS on child health outcomes
Figure 4
Figure 4
Results of systematic review on the effect of IPTp on child health outcomes
Figure 5
Figure 5
Forest plot for the meta-analysis of the effect of IPTp and ITNs used during first or second pregnancy for reducing LBW vs no IPTp (placebo) or ITNs
See this image and copyright information in PMC

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