Lengeler C
Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland, 4002.
Cochrane Database Syst Rev. 2000(2):CD000363. doi: 10.1002/14651858.CD000363.
Malaria is an important cause of illness and death in many parts of the world, especially in Africa. There has been a renewed emphasis on preventive measures, both at community and at individual level. Insecticide treated bednets and curtains are a promising preventive measure.
The objective of this review was to assess the effects of insecticide-treated bednets or curtains in preventing malaria
We searched the Cochrane Infectious Diseases Group trials register, Medline, Embase and the reference lists of articles. We handsearched journals, contacted researchers, funding agencies and net and insecticide manufacturers.
Randomized and quasi-randomized trials of insecticide-treated bednets or curtains with a sufficient dose of a suitable insecticide compared with nets without insecticide or no nets at all. Studies including pregnant women were excluded.
Trial quality was assessed and data extracted by the reviewer. Trial inclusions/exclusions were reviewed by two independent individuals.
Of 65 identified studies, 18 were included. Of these, 11 were randomized by cluster rather than individually. Mortality in children under five was measured in four trials. When impregnated nets were compared with plain nets or no nets, the summary relative risk was 0. 83. This translates to an estimate of protective efficacy of 17%. For treated nets compared with untreated nets, the relative risk of child mortality was 0.77. About six lives can be saved each year for every 1000 children protected with insecticide-treated nets. Insecticide-treated nets also reduced the incidence of mild malarial episodes by 48% (controls=no nets) and 34% (controls=untreated nets).
REVIEWER'S CONCLUSIONS: Insecticide-treated nets appear to be effective in reducing childhood mortality and morbidity from malaria. Widespread access to insecticide-treated nets will require major financial, technical and operational inputs.
疟疾是世界许多地区，尤其是非洲地区疾病和死亡的重要原因。社区和个人层面都重新强调了预防措施。经杀虫剂处理的蚊帐和窗帘是一种很有前景的预防措施。
本综述的目的是评估经杀虫剂处理的蚊帐或窗帘在预防疟疾方面的效果。
我们检索了Cochrane传染病组试验注册库、医学期刊数据库、荷兰医学文摘数据库以及文章的参考文献列表。我们还手工检索了期刊，联系了研究人员、资助机构以及蚊帐和杀虫剂制造商。
将经足够剂量合适杀虫剂处理的蚊帐或窗帘与未使用杀虫剂的蚊帐或根本没有蚊帐进行比较的随机和半随机试验。排除包括孕妇的研究。
由综述作者评估试验质量并提取数据。试验的纳入/排除由两名独立人员进行审查。
在65项已识别的研究中，18项被纳入。其中，11项是整群随机而非个体随机。四项试验测量了五岁以下儿童的死亡率。当将浸渍蚊帐与普通蚊帐或无蚊帐进行比较时，汇总相对风险为0.83。这相当于保护效力估计为17%。对于处理过的蚊帐与未处理的蚊帐相比，儿童死亡率的相对风险为0.77。每1000名使用经杀虫剂处理蚊帐保护的儿童每年大约可挽救6条生命。经杀虫剂处理的蚊帐还使轻度疟疾发作的发生率降低了48%（对照组=无蚊帐）和34%（对照组=未处理的蚊帐）。
经杀虫剂处理的蚊帐似乎可有效降低儿童疟疾死亡率和发病率。要广泛提供经杀虫剂处理的蚊帐，需要大量的资金、技术和运营投入。
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