Insecticide treated bed nets to prevent malaria

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Abstract
Papers p 270 Evidence of the impact of insecticide treated materials, either bed nets or curtains, on morbidity from malaria and mortality from all causes in children has been growing over the past 10-20 years. 1 2 The studies have been carried out mainly, although not exclusively, in Africa (11 clinical trials out of 18 in the Cochrane review), the continent where 80% of all clinical cases and over 90% of all malaria deaths are estimated to occur. These data provide strong evidence that insecticide treated materials can substantially reduce childhood mortality, at least in places where malaria is a major contributor to death. However, all these trials were carried out in a way impossible to reproduce on a large scale and they measured efficacy—the potential impact of insecticide treated materials when implemented in almost ideal conditions. Problems can arise when bed nets are promoted outside the context of a clinical trial—though a paper in this week's BMJ (p 270) also suggests an approach that might circumvent some of them.3 The impact of insecticide treated materials on mortality was determined by intervention studies carried out in four African countries.4–7 All reported …