poster presentation meta-analysis bed nets (22nd cochrane colloquium, hyderabad, india)
TRANSCRIPT
METHODS• AsystematicliteraturereviewwasperformedinMedline,EmbaseandCentral.• AnIndianseachfilterwasdeveloped(includingallIndianStates)tosearchforIndianstudies.
• Inclusionandexclusioncriteria:• Population:studiesdoneinIndiawithlaypeople,communityhealthworkers.• Intervention:studiesontheeffectivenessof(un)treatedbednets.Themin-imumtargetimpregnationdoseofthetreatedbednetswas200mg/m2permethrinoretofenprox,30mg/m2cyfluthrin,20mg/m2alphacyper-methrinor10mg/m2deltamethrin/lambdacyhalothrin.
• Comparison:nobednets.• Malariaoutcomes:parasiteprevalence(=numberofmalariacases(posi-tivebloodslideforanyparasite)dividedbythepopulationundersurveil-lance)wasassessedafteradoor-to-doorfortnightlysurveillancewascar-
riedoutandbloodsmearsofall fever caseswere collected(fingerprickmethod,Figure1).
• Design: observational or ex-perimentalstudies.
• Language/time window: norestriction.
• Theoveralleffectofusing(un)treatedbednetscomparedtonobednetsonmalaria(parasiteprevalence) was investigatedbygroupingall studies inameta-analysis (random-effectsmodel) andcalculatingthepooledriskratios(RR).
RESULTS• Box 1 represents the study selection flowchart. Fourteen from the 16includedtrialswereselectedforthemeta-analysis(duetoavailabilityofdataonmalariacases)
• Studiesweredivided intosubgroupsaccording to theAnnualParasiteIncidence (API); low endemic area (API<2) versus high endemic area(API≥2)(Figure2).
• Meta-analysisshowedthatuntreatedbednetsreducedtheriskofmalariaby58%inlowendemicareas(pooledRR0.42[95%CI;0.30,0.60])andby39%inhighendemicareas(pooledRR0.61[95%CI;0.57,0.65]).Whenusingtreatedbednets, the riskofmalariawas further reduced;by82%(pooledRR0.18[95%CI;0.08,0.42])andby65%(pooledR0.35[95%CI;0.26,0.47]inlowandhighendemicareas,respectively(Box2).
• TheCochraneSystematicReview(randomizednon-Indiantrials,2004)showedthattreatedbednetshadaprotectiveimpactonmalaria(averageRR0.87forstablemalariaareascomparedtonobednetuse).
BEDNETS TO PREVENT MALARIA: META-ANALYSIS OF INDIAN TRIALS CONFIRMING RESULTS OF A COCHRANE SYSTEMATIC REVIEW
HANS VAN REMOORTEL1, EMMY DE BUCK1, PHILIPPE VANDEKERCKHOVE1,2, SATYA PAUL AGARWAL3
References:1WorldMalariaReport2012bytheWorldHealthOrganisation;2LengelerC.CochraneDatabaseofSystematicReviews2004;3Ansarietal.IndianJMalariol2002;4Sreeharietal.JVectorBorneDis2007;5Mittaletal.JVectorBorneDis2012;6Ansarietal.JVectorBorneDis2003;7Devetal.ActaTrop2011;8Bhatiaetal.SocSciMed2004;9Dasetal.SoutheastAsianJTropMedPublicHealth1993;10Sahuetal.ActaTrop2003;11Sahuetal.IndianJMedRes2008;12Bhattetal.MalarJ2012;13Sharmaetal.JAmMosqControlAssoc2006;14Sharmaetal.ActaTrop2009;15Yadavetal.JAmMosqControlAssoc1998;16Yadavetal.JMedEntomol2001;17http://www.nhp.gov.in.
Budget and funding:Thedevelopmentofevidence-basedIndianfirstaidandpreventionguidelineswasfinancedbyBelgianRedCross-Flanderswithco-fundingfromtheBelgianDirectorate-GeneralforDevelopmentCooperation(DGD)
1 BELGIAN RED CROSS-FLANDERS, MECHELEN, BELGIUM 2 DEPARTMENT OF PUBLIC HEALTH AND PRIMARY CARE, CATHOLIC UNIVERSITY OF LEUVEN, LEUVEN, BELGIUM
3 INDIAN RED CROSS SOCIETY, NEW DELHI, INDIA
V.u.
: Phi
lippe
Van
deke
rckh
ove
| Mot
stra
at 4
0, 2
800
Mec
hele
n | 2
014
_153
CONCLUSIONS• Thereisevidencefrom16experimentalIndianstudiesthatusing(insecticidetreated)bednetsisaneffectiveinterventiontopreventmalaria,whichisinlinewiththefindingsoftheCochranesystematicreview,performedoutsideIndia.
• Thepresentfindingssupportthecurrentbednetuse intheNationalVec-torBorneDiseaseControlProgrammeinIndia17andwillbeincludedintheIndianfirstaidandpreventiveguidelines.
INTRODUCTION & OBJECTIVESNewmalariacasesinIndiaareestimatedat24millionperyearbytheWorldHealthOrganization,resultinginahighsocio-economicburden1.ACochranesystematic review, based on randomized controlled trials in non-Indiancountries, showed that insecticide treated bednets are highly effective inreducingmorbidity frommalaria2.Aspartof thedevelopmentofevidence-
based Indian first aid and prevention guidelines, a cooperation betweenBelgianRedCross-Flandersand the IndianRedCrossSociety,weaimedtoinvestigate the effectiveness of both insecticide-treated and untreatedbednetsonmalariainIndianfamilies.
Figure 1. Active malaria detection via the finger prick method.
Figure 2. Classification of the included studies into low endemic versus high endemic area, based on the Annual Parasite Incidence.
Box 2: Meta-analysis with calculation of the pooled effect of treated bed nets on parasite prevalence
Box 1: Study selection flowchart for preventive bednet intervention for malaria, identified in Indian studies(B:levelofevidencemoderateaccordingtoGRADE)
Records identified through database searching (n=479)DetailedsearchstrategyinMedline,EmbaseandCentral.
Title and abstractscreening(n=393)
Full-textarticlesassessedforeligibility(n=28)
Studiesincludedfordataextractionandquantitativesynthesis(n=16)(B):
Clusterrandomizedcontrolledtrials(n=9)Controlledinterruptedtimeseries(n=7)
Recordsexcluded(n=365)
Removingduplicates/triplicates(n=86)
Full-textarticlesexcluded(n=12)-Outcome(n=6)-Design(n=4)-Intervention(n=2)
Iden
tifica
tion
Scre
enin
gEl
igib
ility
Incl
uded
Lowendemicarea(API<2)1.Ansari20023
2.Sreehari20074
3.Mittal20125
4.Ansari20036
Highendemicarea(API≥2)5.Dev20117
6.Bhatia20048
7.Das19939
8.Sahu200310
9.Sahu200811
10.Bhatt201212
11.Sharma200613
12.Sharma200914
13.Yadav199815
14.Yadav200116
0–2 2–5 >5
Annual Parasite Incidence
1
23
4
5
6
78 910
1112 13 14
E IDENCE-BASED PRACTICERealized by the centre for
of the Belgian Red Cross-Flanders