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Impact of community-based interventions for the prevention and control of malaria on intervention coverage and health outcomes for the prevention and control of malaria.

Salam RA, Das JK, Lassi ZS, Bhutta ZA - Infect Dis Poverty (2014)

Bottom Line: We found a non-significant impact on splenomegaly, birth outcomes (low birth weight, prematurity, stillbirth/miscarriage), anthropometric measures (stunting, wasting, and underweight), and mortality (all-cause and malaria-specific).The subgroup analysis suggested that community-based distribution of ITNs, impregnated bed sheets and IRS, and IPT are effective strategies.Qualitative synthesis suggests that high coverage could be achieved at a lower cost with the integration of CBIs with existing antenatal care and immunization campaigns.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan.

ABSTRACT
In this paper, we aim to evaluate the effectiveness of community-based interventions (CBIs) for the prevention and management of malaria. We conducted a systematic review and identified 42 studies for inclusion. Twenty-five of the included studies evaluated the impact of the community-based distribution of insecticide-treated nets (ITNs), indoor residual spraying (IRS), or impregnated bed sheets; 14 studies evaluated intermittent preventive therapy (IPT) delivered in community settings; two studies focused on community-based education for malaria prevention; and one study evaluated environmental management through drain cleaning. Our analysis suggests that, overall, the community-based delivery of interventions to prevent and control malaria resulted in a significant increase in ITNs ownership (RR: 2.16, 95% CI: 1.86, 2.52) and usage (RR: 1.77, 95% CI: 1.48, 2.11). However, usage of ITNs was limited to two-thirds of the population who owned them. Community-based strategies also led to a significant decrease in parasitemia (RR: 0.56, 95% CI: 0.42, 0.74), malaria prevalence (RR: 0.46, 95% CI: 0.29, 0.73), malaria incidence (RR: 0.70, 95% CI: 0.54, 0.90), and anemia prevalence (RR: 0.79, 95% CI: 0.64, 0.97). We found a non-significant impact on splenomegaly, birth outcomes (low birth weight, prematurity, stillbirth/miscarriage), anthropometric measures (stunting, wasting, and underweight), and mortality (all-cause and malaria-specific). The subgroup analysis suggested that community-based distribution of ITNs, impregnated bed sheets and IRS, and IPT are effective strategies. Qualitative synthesis suggests that high coverage could be achieved at a lower cost with the integration of CBIs with existing antenatal care and immunization campaigns. Community-based delivery of interventions to prevent and control malaria are effective strategies to improve coverage and access and reduce malaria burden, however, efforts should also be concerted to prevent over diagnosis and drug resistance.

No MeSH data available.


Related in: MedlinePlus

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Figure 1: Search flow diagram.

Mentions: We identified 1,146 titles from the search conducted in all databases. After screening the titles and abstracts, 187 full texts were reviewed, of which 42 studies (17 RCTs, 10 quasi-experimental trials, 13 before-and-after studies, and two case control studies) were included in the review (see Figure 1). The characteristics of the included studies are summarized in Table 2. Of the 42 studies, four studies could not be included in the meta-analysis as these did not report poolable data [8-11], while for studies reporting multiple evaluations of a single intervention, we pooled the results from the last reported survey [12,13]. From the 17 RCTs included in this review, randomization was adequate in six studies, allocation was concealed in six studies, and adequate sequence generation was done in four studies. None of the studies blinded participants due to the nature of the interventions, while all studies provided insufficient information on selective reporting which limited us from making any judgment (see Table 3).


Impact of community-based interventions for the prevention and control of malaria on intervention coverage and health outcomes for the prevention and control of malaria.

Salam RA, Das JK, Lassi ZS, Bhutta ZA - Infect Dis Poverty (2014)

Search flow diagram.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4128612&req=5

Figure 1: Search flow diagram.
Mentions: We identified 1,146 titles from the search conducted in all databases. After screening the titles and abstracts, 187 full texts were reviewed, of which 42 studies (17 RCTs, 10 quasi-experimental trials, 13 before-and-after studies, and two case control studies) were included in the review (see Figure 1). The characteristics of the included studies are summarized in Table 2. Of the 42 studies, four studies could not be included in the meta-analysis as these did not report poolable data [8-11], while for studies reporting multiple evaluations of a single intervention, we pooled the results from the last reported survey [12,13]. From the 17 RCTs included in this review, randomization was adequate in six studies, allocation was concealed in six studies, and adequate sequence generation was done in four studies. None of the studies blinded participants due to the nature of the interventions, while all studies provided insufficient information on selective reporting which limited us from making any judgment (see Table 3).

Bottom Line: We found a non-significant impact on splenomegaly, birth outcomes (low birth weight, prematurity, stillbirth/miscarriage), anthropometric measures (stunting, wasting, and underweight), and mortality (all-cause and malaria-specific).The subgroup analysis suggested that community-based distribution of ITNs, impregnated bed sheets and IRS, and IPT are effective strategies.Qualitative synthesis suggests that high coverage could be achieved at a lower cost with the integration of CBIs with existing antenatal care and immunization campaigns.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan.

ABSTRACT
In this paper, we aim to evaluate the effectiveness of community-based interventions (CBIs) for the prevention and management of malaria. We conducted a systematic review and identified 42 studies for inclusion. Twenty-five of the included studies evaluated the impact of the community-based distribution of insecticide-treated nets (ITNs), indoor residual spraying (IRS), or impregnated bed sheets; 14 studies evaluated intermittent preventive therapy (IPT) delivered in community settings; two studies focused on community-based education for malaria prevention; and one study evaluated environmental management through drain cleaning. Our analysis suggests that, overall, the community-based delivery of interventions to prevent and control malaria resulted in a significant increase in ITNs ownership (RR: 2.16, 95% CI: 1.86, 2.52) and usage (RR: 1.77, 95% CI: 1.48, 2.11). However, usage of ITNs was limited to two-thirds of the population who owned them. Community-based strategies also led to a significant decrease in parasitemia (RR: 0.56, 95% CI: 0.42, 0.74), malaria prevalence (RR: 0.46, 95% CI: 0.29, 0.73), malaria incidence (RR: 0.70, 95% CI: 0.54, 0.90), and anemia prevalence (RR: 0.79, 95% CI: 0.64, 0.97). We found a non-significant impact on splenomegaly, birth outcomes (low birth weight, prematurity, stillbirth/miscarriage), anthropometric measures (stunting, wasting, and underweight), and mortality (all-cause and malaria-specific). The subgroup analysis suggested that community-based distribution of ITNs, impregnated bed sheets and IRS, and IPT are effective strategies. Qualitative synthesis suggests that high coverage could be achieved at a lower cost with the integration of CBIs with existing antenatal care and immunization campaigns. Community-based delivery of interventions to prevent and control malaria are effective strategies to improve coverage and access and reduce malaria burden, however, efforts should also be concerted to prevent over diagnosis and drug resistance.

No MeSH data available.


Related in: MedlinePlus