Antenatal Malaria Prevention Using ITNs

SourceLocation and Type of TrialInterventionMaternal OutcomePerinatal/Neonatal Outcome
Shulman290Kenya; rural setting; RCT503 pregnant women and their households participated in the study. In the intervention households, nets measuring 190 × 180 × 150 cm were impregnated with permethrin to achieve a target dose of 0.5 g permethrin per m2 of netting.No significant effect of the impregnated net intervention was observed in maternal Hb levels or rates of anemia or placental infection.No significant effect of the intervention was seen on stillbirth rate (RR: 0.67; CI: 0.19–2.32; P = .51). No significant effect on PMR or birth weight was seen.
D'Alessandro et al272The Gambia; rural setting; RCT651 primigravidae lived in study villages; 308 lived in intervention villages, which were provided with insecticide-treated bed nets (20% permethrin). 343 women lived in control villages without bed nets.The prevalence of severe anemia was significantly lower (73% reduction) in villages with treated bed nets compared with control villages, but this effect was limited to the dry season.No significant differences between the 2 village groups were seen for PMR or birth weight. The preterm birth rate was lower (72% reduction) in villages with treated bed nets during the rainy season (OR: 0.28; CI: 0.08–0.97; P = 0.02).
Dolan et al291Thailand; rural setting; DBRCT348 pregnant women were randomly assigned to 1 of 4 groups: 1) 111 women to the permethrin-impregnated (500 mg/m2) bed net (PIB) group, 2) 112 women to the NIB group, 3) 30 women to the no bed net group, and 4) 88 women in the family-size nonimpregnated bed net (FNIB) (These 88 women were originally assigned to the no bed net group, but obtained family-size bed nets and were reclassified.)Women who used their own FNIB or a PIB had fewer episodes of malaria than the combined NIB and no-net groups (PIB 33%, P = .04; FNIB group 32%, P = .07). Thus, the risk of at least 1 attack of malaria was 1.67 (CI: 1.07–2.61) times higher in the NIB and no-net group than in the pooled PIB and FNIB group (P = .03 allowing for parity). Use of PIBs was associated with a reduction in anemia in all camps and in women of all gravidae, independent of the effect on parasitemic malaria.No significant effect of the nets was observed on IMR, birth weight or gestational age at birth.
ter Kuile et al288Kenya; rural setting; RCTAll households in 40 of 79 villages were randomized to receive ITNs. Women were followed monthly through pregnancy to monitor health and birth outcomes.No significant effect of the ITNs was found on preterm birth rates. LBW was lower among ITN users than controls (protective efficacy: 28%; CI: 2–47%). Adjusted mean birth weight was 77.6 g higher during first 4 pregnancies of women in ITN villages (P = .0008).