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

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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.

Original languageEnglish
Article number210
Number of pages13
JournalParasites and Vectors
Volume11
Issue number1
DOIs
Publication statusPublished - 27 Mar 2018

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Malaria
Pharmaceutical Preparations
Biological Science Disciplines
Incidence
Insecticides
Network Meta-Analysis
PubMed
Uncertainty
Databases
Morbidity
Mortality
Infection

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Wangdi, K., Furuya-Kanamori, L., Clark, J., Barendregt, J. J., Gatton, M. L., Banwell, C., ... Clements, A. C. A. (2018). Comparative effectiveness of malaria prevention measures: a systematic review and network meta-analysis. Parasites and Vectors, 11(1), [210]. https://doi.org/10.1186/s13071-018-2783-y
Wangdi, Kinley ; Furuya-Kanamori, Luis ; Clark, Justin ; Barendregt, Jan J ; Gatton, Michelle L ; Banwell, Cathy ; Kelly, Gerard C ; Doi, Suhail A R ; Clements, Archie C A. / Comparative effectiveness of malaria prevention measures : a systematic review and network meta-analysis. In: Parasites and Vectors. 2018 ; Vol. 11, No. 1.
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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.",
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Wangdi, K, Furuya-Kanamori, L, Clark, J, Barendregt, JJ, Gatton, ML, Banwell, C, Kelly, GC, Doi, SAR & Clements, ACA 2018, 'Comparative effectiveness of malaria prevention measures: a systematic review and network meta-analysis' Parasites and Vectors, vol. 11, no. 1, 210. https://doi.org/10.1186/s13071-018-2783-y

Comparative effectiveness of malaria prevention measures : a systematic review and network meta-analysis. / Wangdi, Kinley; Furuya-Kanamori, Luis; Clark, Justin; Barendregt, Jan J; Gatton, Michelle L; Banwell, Cathy; Kelly, Gerard C; Doi, Suhail A R; Clements, Archie C A.

In: Parasites and Vectors, Vol. 11, No. 1, 210, 27.03.2018.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Comparative effectiveness of malaria prevention measures

T2 - a systematic review and network meta-analysis

AU - Wangdi, Kinley

AU - Furuya-Kanamori, Luis

AU - Clark, Justin

AU - Barendregt, Jan J

AU - Gatton, Michelle L

AU - Banwell, Cathy

AU - Kelly, Gerard C

AU - Doi, Suhail A R

AU - Clements, Archie C A

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Y1 - 2018/3/27

N2 - 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.

AB - 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.

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