Insecticide‐treated nets for preventing malaria in pregnancy

Carrol L Gamble; John Paul Ekwaru; Feiko O ter Kuile

doi:10.1002/14651858.CD003755.pub2

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Analysis 1.1

Comparison 1 Insecticide‐treated nets versus no nets, Outcome 1 Severe anaemia.

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Analysis 1.2

Comparison 1 Insecticide‐treated nets versus no nets, Outcome 2 Any anaemia.

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Analysis 1.3

Comparison 1 Insecticide‐treated nets versus no nets, Outcome 3 Haemoglobin (g/L).

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Analysis 1.4

Comparison 1 Insecticide‐treated nets versus no nets, Outcome 4 Low birthweight.

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Analysis 1.5

Comparison 1 Insecticide‐treated nets versus no nets, Outcome 5 Birthweight (kg).

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Analysis 1.6

Comparison 1 Insecticide‐treated nets versus no nets, Outcome 6 Clinical malaria illness during pregnancy.

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Analysis 1.7

Comparison 1 Insecticide‐treated nets versus no nets, Outcome 7 Peripheral parasitaemia.

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Analysis 1.8

Comparison 1 Insecticide‐treated nets versus no nets, Outcome 8 Parasite density.

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Analysis 1.9

Comparison 1 Insecticide‐treated nets versus no nets, Outcome 9 Placental parasitaemia.

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Analysis 1.10

Comparison 1 Insecticide‐treated nets versus no nets, Outcome 10 Fetal loss.

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Table 1. Detailed search strategies

Search set	CIDG SR^a	CENTRAL	MEDLINE^b	EMBASE^b	LILACS^b
1	malaria	malaria	malaria	malaria	malaria
2	pregnan*	pregnan*	pregnan*	pregnan*	pregnan*
3	woman	woman	woman	woman	woman
4	women	women	women	women	women
5	3 or 4	3 or 4	3 or 4	3 or 4	3 or 4
6	1 and 2 and 5	1 and 2 and 5	1 and 2 and 5	1 and 2 and 5	1 and 2 and 5
7	net*	net*	net*	net*	net*
8	ITN*	ITN*	ITN*	ITN*	6 and 7
9	ITM*	ITM*	ITM*	ITM*	—
10	7 or 8 or 9	7 or 8 or 9	7 or 8 or 9	7 or 8 or 9	—
11	6 and 10	6 and 10	6 and 10	6 and 10	—
^aCochrane Infectious Diseases Group Specialized Register. ^bSearch terms used in combination with the search strategy for retrieving trials developed by The Cochrane Collaboration (Higgins 2005); upper case: MeSH or EMTREE heading; lower case: free text term.

Table 1. Detailed search strategies

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Table 2. Risk of bias assessmenta

Trial	Generation of allocation sequence	Allocation concealment	Blinding	Inclusion of all randomized participants in the analysis
Dolan 1993	Method not described	Not described	Double blind (participants, antenatal clinic staff, and supervising physician) for ITNs versus untreated nets comparison	Adequate
Shulman 1998	Adequate	Adequate	Open	Adequate for number with a third trimester blood sample Inadequate for number women who delivered in hospital Adequate for number followed up at least 4 weeks after delivery Adequate for number with a third trimester blood sample Inadequate for number women who delivered in hospital Adequate for number followed up at least 4 weeks after delivery
Browne 2001	Adequate	Adequate	Open	Adequate for number with blood taken in third trimester for malaria and haemoglobin Inadequate for number with pregnancy outcomes reported
Njagi 2002	Adequate	Not described	Open for ITNs versus no nets comparison Double blind for sulfadoxine‐pyrimethamine (SP) versus SP placebo comparison Open for ITNs versus no nets comparison Double blind for sulfadoxine‐pyrimethamine (SP) versus SP placebo comparison	Inadequate for number evaluated at delivery
ter Kuile 2003	Adequate	Adequate	Open	Adequate number for birth outcomes and analysis of outcomes assessing the impact of nets during pregnancy
^aDetails of methods used in individual trials are in the 'Characteristics of included studies'.

Table 2. Risk of bias assessmenta

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Comparison 1. Insecticide‐treated nets versus no nets

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severe anaemia Show forest plot	4		Various (Fixed, 95% CI)	Subtotals only

1.1 Odds ratio (third trimester)	2		Various (Fixed, 95% CI)	0.77 [0.56, 1.08]
1.2 Risk ratio (at delivery)	2		Various (Fixed, 95% CI)	0.98 [0.63, 1.52]
1.3 Hazard ratio	2		Various (Fixed, 95% CI)	0.89 [0.61, 1.31]
2 Any anaemia Show forest plot	5		Various (Random, 95% CI)	Subtotals only

2.1 Odds ratio (third trimester)	1		Various (Random, 95% CI)	0.88 [0.71, 1.10]
2.2 Odds ratio (at delivery)	2		Various (Random, 95% CI)	0.95 [0.50, 1.79]
2.3 Hazard ratio	2		Various (Random, 95% CI)	0.90 [0.71, 1.13]
3 Haemoglobin (g/L) Show forest plot	11		Mean difference (Random, 95% CI)	Subtotals only

3.1 Third trimester: first or second pregnancy	5		Mean difference (Random, 95% CI)	‐0.04 [‐2.41, 2.33]
3.2 Third trimester: third or greater pregnancy	3		Mean difference (Random, 95% CI)	0.30 [‐3.38, 3.97]
3.3 At delivery: first or second pregnancy	3		Mean difference (Random, 95% CI)	1.95 [‐2.61, 6.51]
4 Low birthweight Show forest plot	4		Various (Fixed, 95% CI)	0.80 [0.64, 1.00]

4.1 Risk ratio: first or second pregnancy	3		Various (Fixed, 95% CI)	0.77 [0.61, 0.98]
4.2 Risk ratio: fifth or greater pregnancy	1		Various (Fixed, 95% CI)	1.12 [0.56, 2.24]
5 Birthweight (kg) Show forest plot	10		Mean difference (Fixed, 95% CI)	0.06 [0.02, 0.09]

5.1 First or second pregnancy	8		Mean difference (Fixed, 95% CI)	0.05 [0.02, 0.09]
5.2 Third or greater pregnancy	2		Mean difference (Fixed, 95% CI)	0.08 [‐0.13, 0.28]
6 Clinical malaria illness during pregnancy Show forest plot	2		Various (Fixed, 95% CI)	Totals not selected

6.1 Odds ratio	1		Various (Fixed, 95% CI)	0.0 [0.0, 0.0]
6.2 Hazard ratio	1		Various (Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Peripheral parasitaemia Show forest plot	6		Various (Fixed, 95% CI)	Subtotals only

7.1 Odds ratio: third trimester	2		Various (Fixed, 95% CI)	0.88 [0.73, 1.06]
7.2 Risk ratio: at delivery	4		Various (Fixed, 95% CI)	0.76 [0.67, 0.86]
7.3 Hazard ratio	2		Various (Fixed, 95% CI)	0.67 [0.52, 0.86]
8 Parasite density Show forest plot	8		Geometric mean ratio (Fixed, 95% CI)	0.93 [0.77, 1.11]

8.1 First or second pregnancy	6		Geometric mean ratio (Fixed, 95% CI)	0.82 [0.66, 1.02]
8.2 Third or greater pregnancy	2		Geometric mean ratio (Fixed, 95% CI)	1.28 [0.90, 1.82]
9 Placental parasitaemia Show forest plot	5		Risk Ratio (Random, 95% CI)	0.79 [0.63, 0.98]

9.1 First or second pregnancy	4		Risk Ratio (Random, 95% CI)	0.82 [0.61, 1.11]
9.2 Fifth or greater pregnancy	1		Risk Ratio (Random, 95% CI)	0.72 [0.48, 1.08]
10 Fetal loss Show forest plot	5		Risk Ratio (Fixed, 95% CI)	0.68 [0.48, 0.98]

10.1 First or second pregnancy	4		Risk Ratio (Fixed, 95% CI)	0.67 [0.47, 0.97]
10.2 Fifth or greater pregnancy	1		Risk Ratio (Fixed, 95% CI)	1.02 [0.17, 6.23]

Comparison 1. Insecticide‐treated nets versus no nets

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