An analysis of studies from 12 countries across Africa and Asia, including India and China, confirms that insecticide-treated nets are effective in cutting malaria cases, but challenges such as mosquitoes' resistance to insecticides could undermine long-term effectiveness. While insecticide-treated nets continue to provide a strong protection against malaria, findings published in the journal Infectious Diseases suggest that performance of the relatively simple, low-cost intervention could be under pressure, especially in places where insecticide resistance is established, researchers said.

"While this study reinforces that ITNs (insecticide-treated nets) remain one of the most powerful weapons we have against malaria, it is also a warning that we cannot afford to become complacent," author Dr Gbeminiyi Otolorin, a doctoral researcher at James Cook University in Australia, and a veterinary public health clinician and researcher at Nigeria's University of Jos, said.

"Mosquitoes are developing (a) resistance and adapting their behaviour -- and a tool that works well in one place may already be failing in another. We must continuously monitor, evaluate and tailor our control strategies as we strive towards global elimination of the disease," Dr Otolorin said.

Twenty-five studies, which compared the performance of insecticide-treated nets against the use of no nets, were analysed. Out of these, 19 examined malaria incidence, and six examined malaria-related deaths, spanning eight African (including Gambia, Ghana and Kenya) and four Asian countries.

The analysis "confirmed an overall significant protective effect of ITNs against malaria" and findings "reinforce the continued importance of ITNs as a cornerstone intervention for malaria prevention across endemic settings".

In Asia, ITNs were associated with a 68 per cent reduction in malaria cases and an 18 per cent reduction in malaria-related deaths, while In Africa, the intervention reduced malaria incidence by between 29 per cent and 40 per cent.

Complex local factors, including mosquito species diversity, patterns of insecticide resistance and community compliance with net use, could influence considerable variation in the effectiveness of ITNs between studies, particularly in Asia, the researchers said.

However, a continued innovation in vector (mosquito) control might be required to sustain and enhance gains made in cutting malaria incidence and deaths, the authors said.

"Next-generation insecticide-treated nets, including pyrethroid-piperonyl butoxide (PBO) nets and other dual-active-ingredient ITNs, may help address the growing challenge of insecticide resistance," they suggested.

Insecticide-treated nets will also need to be integrated into broader vector management strategies, which may include measures such as indoor spraying and insecticidal wall linings, the team said.

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