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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.


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Forest plot for the impact of CBIs on malaria prevalence.
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Figure 5: Forest plot for the impact of CBIs on malaria prevalence.

Mentions: Table 4 depicts the impact of the overall community-based delivery of interventions and the subgroup analysis according to the type of study and intervention. Overall, community-based delivery of interventions to prevent and control malaria resulted in a significantly higher ownership (RR: 2.16, 95% CI: 1.86, 2.52) and usage (RR: 1.77, 95% CI: 1.48, 2.11) of ITNs in the intervention group as compared to the control group (see Figures 2 and 3). Ownership was defined as households having at least one net at the time of the survey, while usage was defined as having slept under an ITN the previous night or having an ITN hanging over the bed. The usage rate of ITNs among people who owned an ITN was around 66%. Community-based delivery strategy was also associated with significantly lower malaria incidence (RR: 0.70, 95% CI: 0.54, 0.90), parasitemia (RR: 0.56, 95% CI: 0.42, 0.74), and malaria prevalence (RR: 0.46, 95% CI: 0.29, 0.73) in the intervention group (see Figures 4 and 5). Anemia prevalence also reduced significantly (RR: 0.79, 95% CI: 0.64, 0.97) with sensitivity analysis after removing Eriksen 2010 (which reported concurrent interventions in both groups due to the introduction of a national campaign during the study period) (see Figure 6). We found non-significant impact on mean hemoglobin, splenomegaly, birth outcomes (low birth weight [LBW], prematurity, stillbirth/miscarriage), anthropometric measures (stunting, wasting, and underweight), and mortality (all-cause and malaria-specific). These findings are based on limited number of studies pooled with a high level of heterogeneity and hence should be interpreted with caution. The subgroup analysis for integrated and non-integrated delivery showed significant impacts on all outcome indicators except for malaria prevalence and splenomegaly which was non-significant for the integrated delivery subgroup, though this is based on a limited number of studies.


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)

Forest plot for the impact of CBIs on malaria prevalence.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Forest plot for the impact of CBIs on malaria prevalence.
Mentions: Table 4 depicts the impact of the overall community-based delivery of interventions and the subgroup analysis according to the type of study and intervention. Overall, community-based delivery of interventions to prevent and control malaria resulted in a significantly higher ownership (RR: 2.16, 95% CI: 1.86, 2.52) and usage (RR: 1.77, 95% CI: 1.48, 2.11) of ITNs in the intervention group as compared to the control group (see Figures 2 and 3). Ownership was defined as households having at least one net at the time of the survey, while usage was defined as having slept under an ITN the previous night or having an ITN hanging over the bed. The usage rate of ITNs among people who owned an ITN was around 66%. Community-based delivery strategy was also associated with significantly lower malaria incidence (RR: 0.70, 95% CI: 0.54, 0.90), parasitemia (RR: 0.56, 95% CI: 0.42, 0.74), and malaria prevalence (RR: 0.46, 95% CI: 0.29, 0.73) in the intervention group (see Figures 4 and 5). Anemia prevalence also reduced significantly (RR: 0.79, 95% CI: 0.64, 0.97) with sensitivity analysis after removing Eriksen 2010 (which reported concurrent interventions in both groups due to the introduction of a national campaign during the study period) (see Figure 6). We found non-significant impact on mean hemoglobin, splenomegaly, birth outcomes (low birth weight [LBW], prematurity, stillbirth/miscarriage), anthropometric measures (stunting, wasting, and underweight), and mortality (all-cause and malaria-specific). These findings are based on limited number of studies pooled with a high level of heterogeneity and hence should be interpreted with caution. The subgroup analysis for integrated and non-integrated delivery showed significant impacts on all outcome indicators except for malaria prevalence and splenomegaly which was non-significant for the integrated delivery subgroup, though this is based on a limited number of studies.

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