Insecticide treated nets beneficial for pregnant women in malaria-endemic Africa

No more need for clinical trials. A systematic review of currently available literature published this week in The Cochrane Library, Issue 2, 2006 shows that insecticide treated nets (ITNs) reduces placental malaria, low birth weight, and abortions and stillbirths in women living in malaria affected regions of Africa. The benefit is most noticeable in women during their first two to four pregnancies, and the effect is seen if the ITNs are used by whole communities or by individual women.

“The evidence is clear – no further trials of ITNs are needed in sub-Saharan Africa, instead efforts should focus on improving their availability to pregnant women,” says lead Review Author Dr Feiko ter Kuile, from the Liverpool School of Tropical Medicine, UK.

There is a need, however, for further research in areas of the world such as Asia and Latin America where malaria is present, but at a lower level. The Review Authors found only one trial that had been performed outside of Africa. This study from Thailand showed that ITNs reduced the amount of anaemia in women and reduced the numbers of babies dying before birth, but the nets did not appear to ward off other problems.

Pregnant women are particularly susceptible to malaria, and approximately 50 million pregnant women are exposed to malaria each year. This places both mother and baby at risk. Despite this, only a handful out of 80 studies of ITNs were randomised trials that looked at the effect of the nets on pregnant women.

“ITNs should be an integral part of strategies to prevent malaria in pregnant women living in areas of Africa where malaria is endemic,” say Gamble and ter Kuile.