Comparative effectiveness of malaria prevention measures: a systematic review and network meta-analysis

Kinley Wangdi; Luis Furuya-Kanamori; Justin Clark; Jan J Barendregt; Michelle L Gatton; Cathy Banwell; Gerard C Kelly; Suhail A R Doi; Archie C A Clements

doi:10.1186/s13071-018-2783-y

Comparative effectiveness of malaria prevention measures: a systematic review and network meta-analysis

Parasit Vectors. 2018 Mar 27;11(1):210. doi: 10.1186/s13071-018-2783-y.

Authors

Kinley Wangdi¹, Luis Furuya-Kanamori^{2

3}, Justin Clark⁴, Jan J Barendregt^{5

6}, Michelle L Gatton⁷, Cathy Banwell², Gerard C Kelly², Suhail A R Doi^{2

3}, Archie C A Clements²

Affiliations

¹ Research School of Population Health, College of Health and Medicine, The Australian National University, ACT, Canberra, Australia. kinley.wangdi@anu.edu.au.
² Research School of Population Health, College of Health and Medicine, The Australian National University, ACT, Canberra, Australia.
³ Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar.
⁴ Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
⁵ School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
⁶ Epigear International Pty Ltd, Sunrise Beach, Queensland, Australia.
⁷ School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.

Abstract

Background: Malaria causes significant morbidity and mortality worldwide. There are several preventive measures that are currently employed, including insecticide-treated nets (ITNs, including long-lasting insecticidal nets and insecticidal-treated bed nets), indoor residual spraying (IRS), prophylactic drugs (PD), and untreated nets (UN). However, it is unclear which measure is the most effective for malaria prevention. We therefore undertook a network meta-analysis to compare the efficacy of different preventive measures on incidence of malaria infection.

Methods: A systematic literature review was undertaken across four medical and life sciences databases (PubMed, Cochrane Central, Embase, and Web of Science) from their inception to July 2016 to compare the effectiveness of different preventive measures on malaria incidence. Data from the included studies were analysed for the effectiveness of several measures against no intervention (NI). This was carried out using an automated generalized pairwise modeling (GPM) framework for network meta-analysis to generate mixed treatment effects against a common comparator of no intervention (NI).

Results: There were 30 studies that met the inclusion criteria from 1998-2016. The GPM framework led to a final ranking of effectiveness of measures in the following order from best to worst: PD, ITN, IRS and UN, in comparison with NI. However, only ITN (RR: 0.49, 95% CI: 0.32-0.74) showed precision while other methods [PD (RR: 0.24, 95% CI: 0.004-15.43), IRS (RR: 0.55, 95% CI: 0.20-1.56) and UN (RR: 0.73, 95% CI: 0.28-1.90)] demonstrating considerable uncertainty associated with their point estimates.

Conclusion: Current evidence is strong for the protective effect of ITN interventions in malaria prevention. Even though ITNs were found to be the only preventive measure with statistical support for their effectiveness, the role of other malaria control measures may be important adjuncts in the global drive to eliminate malaria.

Keywords: Efficacy; Malaria; Meta-analysis; Preventive measures.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Biostatistics
Communicable Disease Control / methods*
Disease Transmission, Infectious / prevention & control*
Humans
Incidence
Malaria / epidemiology*
Malaria / prevention & control*
Network Meta-Analysis
Treatment Outcome