title: Effectiveness of insecticide-treated and untreated nets to prevent malaria in India.
abstract: OBJECTIVE
  India is the most malaria-endemic country in South-East Asia, resulting in a high socio-economic burden. Insecticide-treated or untreated nets are effective interventions to prevent malaria. As part of an Indian first-aid guideline project, we aimed to investigate the magnitude of this effect in India.
  
  
  METHODS
  We searched MEDLINE, Embase and Central to systematically review Indian studies on the effectiveness of treated or untreated vs. no nets. Parasite prevalence and annual parasite incidence served as malaria outcomes. The overall effect was investigated by performing meta-analyses and calculating the pooled risk ratios (RR) and incidence rate ratios.
  
  
  RESULTS
  Of 479 articles, we finally retained 16 Indian studies. Untreated nets decreased the risk of parasite prevalence compared to no nets [RR 0.69 (95% CI; 0.55, 0.87) in high-endemic areas, RR 0.49 (95% CI; 0.28, 0.84) in low-endemic areas], as was the case but more pronounced for treated nets [RR 0.35 (95% CI; 0.26, 0.47) in high-endemic areas, risk ratio 0.16 (95% CI; 0.06, 0.44) in low-endemic areas]. Incidence rate ratios showed a similar observation: a significantly reduced rate of parasites in the blood for untreated nets vs. no nets, which was more pronounced in low-endemic areas and for those who used treated nets. The average effect of treated nets (vs. no nets) on parasite prevalence was higher in Indian studies (RR 0.16-0.35) than in non-Indian studies (data derived from a Cochrane systematic review; RR 0.58-0.87).
  
  
  CONCLUSIONS
  Both treated and untreated nets have a clear protective effect against malaria in the Indian context. This effect is more pronounced there than in other countries.
authors: Belgian Red Cross-Flanders, Mechelen, Belgium.
authors: Hans
authors: H
authors: Van Remoortel
authors: Belgian Red Cross-Flanders, Mechelen, Belgium.
authors: Emmy
authors: E
authors: De Buck
authors: Department of Trauma Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors: Maneesh
authors: M
authors: Singhal
authors: Belgian Red Cross-Flanders, Mechelen, Belgium.|Department of Public Health and Primary Care, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.|Faculty of Medicine, University of Ghent, Ghent, Belgium.
authors: Philippe
authors: P
authors: Vandekerckhove
authors: Indian Red Cross Society, New Delhi, India.
authors: Satya P
authors: SP
authors: Agarwal
mesh_terms: D001512:Bedding and Linens; D006801:Humans; D007194:India / Q000453:epidemiology; D007306:Insecticides; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods*; D011322:Primary Prevention
chemical_list: D007306:Insecticides
keywords: Inde; India; Malaria; insecticide-treated bed nets; malaria; mosquiteras; mosquiteras impregnadas con insecticida; mosquito nets; moustiquaires; moustiquaires imprégnées d'insecticide; paludisme; prevención primaria; primary prevention; prévention primaire; revisión sistemática; revue systématique; systematic review