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. 2018 Mar 27;11(1):210.
doi: 10.1186/s13071-018-2783-y.

Comparative effectiveness of malaria prevention measures: a systematic review and network meta-analysis

Kinley Wangdi  1 , Luis Furuya-Kanamori  2   3 , Justin Clark  4 , Jan J Barendregt  5   6 , Michelle L Gatton  7 , Cathy Banwell  2 , Gerard C Kelly  2 , Suhail A R Doi  2   3 , Archie C A Clements  2
Affiliations

Comparative effectiveness of malaria prevention measures: a systematic review and network meta-analysis

Kinley Wangdi et al. Parasit Vectors. .

Abstract

Background: Malaria causes significant morbidity and mortality worldwide. There are several preventive measures that are currently employed, including insecticide-treated nets (ITNs, including long-lasting insecticidal nets and insecticidal-treated bed nets), indoor residual spraying (IRS), prophylactic drugs (PD), and untreated nets (UN). However, it is unclear which measure is the most effective for malaria prevention. We therefore undertook a network meta-analysis to compare the efficacy of different preventive measures on incidence of malaria infection.

Methods: A systematic literature review was undertaken across four medical and life sciences databases (PubMed, Cochrane Central, Embase, and Web of Science) from their inception to July 2016 to compare the effectiveness of different preventive measures on malaria incidence. Data from the included studies were analysed for the effectiveness of several measures against no intervention (NI). This was carried out using an automated generalized pairwise modeling (GPM) framework for network meta-analysis to generate mixed treatment effects against a common comparator of no intervention (NI).

Results: There were 30 studies that met the inclusion criteria from 1998-2016. The GPM framework led to a final ranking of effectiveness of measures in the following order from best to worst: PD, ITN, IRS and UN, in comparison with NI. However, only ITN (RR: 0.49, 95% CI: 0.32-0.74) showed precision while other methods [PD (RR: 0.24, 95% CI: 0.004-15.43), IRS (RR: 0.55, 95% CI: 0.20-1.56) and UN (RR: 0.73, 95% CI: 0.28-1.90)] demonstrating considerable uncertainty associated with their point estimates.

Conclusion: Current evidence is strong for the protective effect of ITN interventions in malaria prevention. Even though ITNs were found to be the only preventive measure with statistical support for their effectiveness, the role of other malaria control measures may be important adjuncts in the global drive to eliminate malaria.

Keywords: Efficacy; Malaria; Meta-analysis; Preventive measures.

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Conflict of interest statement

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Not applicable.

Competing interests

Authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Search flowchart. Note: details of excluded studies in Additional file 1: Table S5
Fig. 2
Fig. 2
Network plot showing the comparison groups. The circle size is proportional to the number of studies including that intervention while line width is proportional to the number of comparisons. Abbreviations: ITN, insecticide-treated nets; UN, untreated net; IRS, indoor residual spraying; NI, no intervention; PD, prophylactic drug
Fig. 3
Fig. 3
Results of network meta-analysis of 30 studies comparing listed interventions against NI. Only the PD-NI mixed effects showed modest inconsistency and this is reflected in the marked uncertainty (wide 95% confidence intervals) of the effect estimate
See this image and copyright information in PMC

References

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