The Effectiveness of Insecticide-Impregnated Bed Nets in Reducing Cases of Malaria Infection: A Meta-Analysis of Published Results

Han W. ChoiPrevention Effectiveness Activity, Office of the Director, Epidemiology Program Office, Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

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Joel G. BremanPrevention Effectiveness Activity, Office of the Director, Epidemiology Program Office, Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

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Steven M. TeutschPrevention Effectiveness Activity, Office of the Director, Epidemiology Program Office, Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

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Simin LiuPrevention Effectiveness Activity, Office of the Director, Epidemiology Program Office, Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

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Allen W. HightowerPrevention Effectiveness Activity, Office of the Director, Epidemiology Program Office, Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

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John D. SextonPrevention Effectiveness Activity, Office of the Director, Epidemiology Program Office, Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

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The use of insecticide-impregnated bed nets to minimize human-vector contact may reduce the incidence of malaria. Consequently, several field trials have evaluated their effectiveness as a malaria prevention strategy. A meta-analysis of published reports of field trials that measured the incidence of infections was performed to provide a measure of the effectiveness of insecticide-treated bed nets in preventing clinical malaria. Subsetted analyses were performed on the 10 field trials to calculate pooled incidence rate ratios of infection among the study groups. For the studies comparing insecticide-impregnated bed nets with untreated bed nets, the summary incidence rate ratio for acquiring malarial infections was 0.757 (95% confidence interval [CI] = 0.612–0.938), representing a reduction of 24%. For the studies comparing permethrin-impregnated bed nets with controls without bed nets, the summary incidence rate ratio was 0.497 (95% CI = 0.417–0.592) (Rothman-Boice heterogeneity statistics = 17.27 [P = 0.004] and 23.55 [P = 0.0003], respectively). These data suggest that insecticide-impregnated bed nets are effective in preventing malaria, decreasing the incidence rate ratio by approximately 50% in field trials performed to date.

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