Spraying houses with insecticides (indoor residual spraying; IRS) to kill mosquitoes is one of the main methods that have been used to control malaria on a large scale. IRS has helped to eliminate malaria from great parts of Asia, Russia, Europe, and Latin America, and successful IRS programmes have also been run in parts of Africa. Another successful method of mosquito control relies on the use of physical barriers such as bednets or curtains that can also be sprayed with insecticides (insecticide treated nets; ITN). This review aims to look at the health benefits of IRS and to compare this method with ITNs.
This review does not assess the potentially adverse effects of insecticides used for IRS, and it includes not only randomized controlled trials (RCTs), but also controlled before-and-after studies (CBA) and interrupted time series (ITS), as these methods were considered suitably rigorous.
Six studies were identified for inclusion (four cluster RCTs, one CBA and one ITS). Four of these studies were conducted in sub-Saharan Africa, one in India and one in Pakistan. IRS reduced malaria transmission in young children by half compared to no IRS in Tanzania (an area where people are regularly exposed to malaria), and protected all age groups in India and Pakistan (where malaria transmission is more unstable and where more than one type of malaria is found).
When compared with ITNs, IRS appeared more protective (according to the outcome chosen) in one trial conducted in an area of stable malaria transmission, but ITN seemed to be more protective than IRS in unstable areas. Unfortunately, the level of evidence is very limited and no firm conclusions should be drawn on the basis of this review.
In conclusion, although IRS programmes have shown impressive success in malaria reduction throughout the world, there are too few well-run trials to be able to quantify the effects of IRS in areas with different malaria transmission, or to properly compare IRS and ITN. High-quality and long-duration trials on a large scale, done in areas where there has been little or no mosquito control are still urgently required. New trials should include an IRS arm and an ITN arm, and should also assess the combined effect of ITN and IRS, a very important question in view of malaria elimination.
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006657/frame.html
Showing posts with label Cochrane. Show all posts
Showing posts with label Cochrane. Show all posts
Friday, 15 October 2010
Friday, 18 June 2010
MALARIA: Iron supplements should not be witheld
Wednesday, July 08, 2009 6:38:27 AM by ANI -Washington, July 8 (ANI): A new review by Cochrane Researchers suggests that iron supplements do not increase the likelihood of contracting malaria and should not be withheld from children at risk of the disease.
“Based on our review, children should not be denied iron supplements, even if they are living in areas where malaria is prevalent. Iron is important for growth and development, and maintaining a healthy immune system,” says lead researcher Juliana Ojukwu of the Department of Paediatrics at the Ebonyi State University in Ebonyi State, Nigeria.
Until 2007, World Health Organisation (WHO) guidelines recommended that all children should be given iron supplements to help prevent iron deficiency and anaemia, which are significant public health problems in developing countries. It is estimated that iron deficiency is the cause of 726,000 childhood deaths each year.
However, a recent large trial in Zanzibar prompted the WHO to change its guidelines, which now recommend that iron supplements are withheld from children under two years in areas where they are at high risk of contracting malaria.
The argument against giving iron is that it could help promote the growth of malarial parasites circulating in the blood.
In response to this, Cochrane researchers reviewed data from 68 different trials involving 42,981 children.
They concluded that iron did not increase the risk of malaria, as long as regular malaria surveillance and treatment services were available, and that there should not be any need to screen for anaemia before giving supplements.
They say WHO guidelines rely too heavily a single recent trial, whereas this current research drew its conclusions after giving appropriate weight to a wide range of studies.
Although the benefits of giving iron are greater for children with anaemia, any decision to withhold iron supplements should be carefully considered.
“Any potential negative effects of giving iron have to be weighed against the quite serious implications of not giving it, namely anaemia and its contribution to childhood infection and death, especially in Sub-Saharan Africa,” said Ojukwu. (ANI)
http://www2.cochrane.org/reviews/en/ab006589.html
“Based on our review, children should not be denied iron supplements, even if they are living in areas where malaria is prevalent. Iron is important for growth and development, and maintaining a healthy immune system,” says lead researcher Juliana Ojukwu of the Department of Paediatrics at the Ebonyi State University in Ebonyi State, Nigeria.
Until 2007, World Health Organisation (WHO) guidelines recommended that all children should be given iron supplements to help prevent iron deficiency and anaemia, which are significant public health problems in developing countries. It is estimated that iron deficiency is the cause of 726,000 childhood deaths each year.
However, a recent large trial in Zanzibar prompted the WHO to change its guidelines, which now recommend that iron supplements are withheld from children under two years in areas where they are at high risk of contracting malaria.
The argument against giving iron is that it could help promote the growth of malarial parasites circulating in the blood.
In response to this, Cochrane researchers reviewed data from 68 different trials involving 42,981 children.
They concluded that iron did not increase the risk of malaria, as long as regular malaria surveillance and treatment services were available, and that there should not be any need to screen for anaemia before giving supplements.
They say WHO guidelines rely too heavily a single recent trial, whereas this current research drew its conclusions after giving appropriate weight to a wide range of studies.
Although the benefits of giving iron are greater for children with anaemia, any decision to withhold iron supplements should be carefully considered.
“Any potential negative effects of giving iron have to be weighed against the quite serious implications of not giving it, namely anaemia and its contribution to childhood infection and death, especially in Sub-Saharan Africa,” said Ojukwu. (ANI)
http://www2.cochrane.org/reviews/en/ab006589.html
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