***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A group-r and omized controlled trial of insecticide (permethrin)-treated bed nets ( ITNs ) was conducted in an area of high perennial malaria transmission in western Kenya to test the effect of ITNs on  all-cause mortality in children 1 - 59 months of age . Child deaths were monitored over a two-year period by biannual household census in Asembo ( 1997 - 1998 ) and in Gem ( 1998 - 1999 ) . Overall , 1,722 deaths occurred in children 1 - 59 months followed for 35,932 child-years .  Crude mortality rates/1,000  child-years were 51.9 versus 43.9 in control and ITN villages in children 1 - 59 months old . The protective efficacy ( PE ) ( 95 % confidence interval ) adjusted for age , study year , study site , and season was 16 % ( 6 - 25 % ) . Corresponding figures in 1 - 11- and 12 - 59-month-old children in control and ITN villages were 133.3 versus 102.3 , PE = 23 % ( 11 - 34 % ) and 31.1 versus 28.7 , PE = 7 % ( -6 - 19 % ) . The numbers of lives saved/1,000 child-years were 8 , 31 , and 2 for the groups 1 - 59 , 1 - 11 , and 12 - 59 months old , respectively . Stratified analysis by time to insecticide re-treatment showed that the PE of  ITNs  re-treated per study protocol ( every six months ) was 20 % ( 10 - 29 % ) , overall and 26 % ( 12 - 37 % ) and 14 % ( -1 - 26 % ) in 1 - 11- and 12 - 59-month-old children , respectively . ITNs prevent approximately one in four infant deaths in areas of intense perennial malaria transmission , but their efficacy is compromised if re-treatment is delayed beyond six months Spatial analyses of the effect of insecticide (permethrin)-treated bed nets ( ITNs ) on nearby households both with and without ITNs was performed in the context of a large-scale , group-r and omized , controlled mortality trial in Asembo , western Kenya . Results illustrate a protective effect of ITNs on compounds lacking ITNs located within 300 meters of compounds with ITNs for child mortality , moderate anemia , high-density parasitemia , and hemoglobin levels . This community effect on nearby compounds without nets is approximately as strong as the effect observed within villages with ITNs . This implies that in areas with intense malaria transmission with high ITN coverage , the primary effect of insecticide-treated nets is via area-wide effects on the mosquito population and not , as commonly supposed , by simple imposition of a physical barrier protecting individuals from biting . The strength of the community effect depended upon the proportion of nearby compounds with treated nets . To maximize their public health impact , high coverage with treated nets is essential BACKGROUND In areas of endemic transmission , malaria in pregnancy is associated with severe maternal anaemia and low-birthweight babies . We studied the efficacy of intermittent treatment doses of sulphadoxine-pyrimethamine in preventing malaria and severe anaemia in pregnancy in a double-blind placebo-controlled trial among primigravid women living in Kilifi District , Kenya . METHODS Between January , 1996 , and April , 1997 , 1264 primigravid women were recruited when they attended for antenatal care , and r and omly assigned sulphadoxine-pyrimethamine ( 640 ) or placebo ( 624 ) . Women received one , two , or three doses of study medication depending on the duration of gestation at enrolment . Primary outcome measures were severe anaemia ( haemoglobin < 8 g/dL ) and malaria parasitaemia , assessed at 34 weeks of gestation . Analyses were based on intention to treat among women who had study blood tests at 34 weeks . FINDINGS 30 ( 5.3 % ) of 567 women in the sulphadoxine-pyrimethamine group and 199 ( 35.3 % ) of 564 in the placebo group had peripheral parasitaemia ( protective efficacy 85 % [ 95 % CI 78 - 90 ] , p<0.0001 ) . 82 ( 14.5 % ) and 134 ( 23.7 % ) had severe anaemia ( protective efficacy 39 % [ 22 - 52 ] , p<0.0001 ) . Even women who booked late and received only one dose of sulphadoxine-pyrimethamine benefited significantly from the intervention . The effects were seen both in women who owned insecticide-treated bednets and in women who did not . INTERPRETATION Intermittent presumptive treatment with sulphadoxine-pyrimethamine is an effective , practicable strategy to decrease the risk of severe anaemia in primigravidae living in malarious areas The efficacy of nets treated with lambda-cyhalothrin , a pyrethroid insecticide , on  malaria infection and disease  was assessed for the first time at the community level in Anopheles gambiae pyrethroid resistance areas . The study was carried out in northern Côte d'Ivoire , which is an area of kdr resistance . Four pairs of villages were selected and matched according to demographic , sociological , and ecological criteria . Among each pair , a village was r and omly allocated to receive mosquito nets . More than 80 % of beds were covered with nets treated with lambda-cyhalothrin and retreated after 6 months . In each village , 54 children aged 0 - 59 months were r and omly selected and clinical ly monitored for 8 periods of 7 days throughout the year . Results showed that the efficacy of treated nets was maintained with a reduction of the prevalence of asymptomatic malaria infection by 12 % and an estimated protective efficacy against malaria disease of 56 % Adherence with permethrin-treated bed net ( ITN ) use and their proper deployment was directly observed in 2,178 individuals ( 784 households ) participating in a large-scale trial of ITNs on child mortality in western Kenya . The ITNs were distributed free of charge to ensure high coverage , result ing in a ratio of 1.46 persons per ITN . Approximately 30 % of ITNs present were unused . The overall percentage adherence was 72.3 % . The probability of adherence by individuals depended strongly on age ( relative risk [ RR ] = 0.86 , 95 % confidence limit [ CL ] = 0.78 - 0.94 ) , in which children less than five years of age were less likely to use ITNs than older individuals , and temperature , in which ITNs were more likely to be used in periods of cooler weather . A marginally significant diminution in adherence during the second year of the project was also observed ( RR = 0.83 , 95 % CL = 0.68 - 1.01 ) . Mosquito numbers , relative wealth , number of house occupants , and the educational level of the head of the household had no effect on adherence . In unstructured question ing of house residents , excessive heat was often cited as a reason for not deploying the child 's ITN . The most important reason for non-adherence was disruption of sleeping arrangements , indicating that ITNs were not readily redeployed in the face of shifting sleeping patterns due to visitors , funerals , house construction , and other events . Challenges faced by health education programs to maximize adherence with ITN use are discussed New tools to prevent malaria morbidity and mortality are needed to improve child survival in sub-Saharan Africa .  Insecticide treated bednets ( ITBN ) have been shown , in one setting ( The Gambia , West Africa ) , to reduce childhood mortality . To assess the impact of ITBN on child survival under different epidemiological and cultural conditions we conducted a community r and omized , controlled trial of permethrin treated bednets ( 0.5 g/m2 ) among a rural population on the Kenyan Coast . Between 1991 and 1993 continuous community-based demographic surveillance linked to hospital-based in-patient surveillance identified all mortality and severe malaria morbidity events during a 2-year period among a population of over 11000 children under 5 years of age . In July 1993 , 28 r and omly selected communities were issued ITBN , instructed in their use and the nets re-impregnated every 6 months . The remaining 28 communities served as contemporaneous controls for the following 2 years , during which continuous demographic and hospital surveillance was maintained until the end of July 1995 . The introduction of ITBN led to significant reductions in childhood mortality ( PE 33 % , CI 7 - 51 % ) and severe , life-threatening malaria among children aged 1 - 59 months ( PE 44 % , CI 19 - 62 ) . These findings confirm the value of ITBN in improving child survival and provide the first evidence of their specific role in reducing severe morbidity from malaria Malarial infection during pregnancy increases the risks of severe sequelae for the pregnant woman and the risk of delivering a low birthweight baby . The aim of this intervention study was to reduce significantly the prevalence of malaria parasitaemia in adolescent parturients in Matola and Boane in Mozambique . The study was focused upon the most malaria-vulnerable group , adolescent nulliparous and primiparous women . After completing the usual antenatal clinic and giving informed consent , 600 pregnant women were r and omly chosen in a double blind manner to one of two regimens comparing the prevailing routine ( placebo ) for malaria prevention with a two dose regimen of sulphadoxine-pyrimethamine ( SP ) . The first dose was given at enrollment with a second dose at the beginning of the third trimester . At delivery maternal and placental malaria parasitaemia as well as birthweight and gestational duration were analysed . At booking the prevalence of malaria parasitaemia was 35.3 % in the placebo group and 30.6 % in the SP group . At the second dose , the prevalence of malaria parasitaemia in the placebo group and SP group was 19.7 % and 8.7 % , respectively . This implies a relative risk ( RR ) of 2.24 with 95 % CI ( 1.34 , 3.75 ) . The corresponding figures at delivery were 13.6 % and 6.3 % with an RR of 2.22 ( 1.07 , 4.60 ) and in placenta 13.3 % and 2.4 % with an RR of 4.87 ( 1.58 , 15.0 ) . Newborns with malaria within 7 days were significantly more frequent in the placebo group , 6.4 % and 0.7 % respectively , with an RR of 6.55 ( 1.20 , 35.7 ) . Almost all ( approximately 98 % ) of the women studied had Plasmodium falciparum , the remainder had P. malariae and P. ovale . The mean birthweight in the SP group was 3077 g and in the placebo group 2926 g. The estimated mean difference between the two groups was 151 g with 95 % CI ( 51 , 252 ) . The mean placental weight in the placebo group was 596 and 645 g in the SP group , implying a difference of 49 g with a 95 % CI ( 11 , 88 ) . The mean gestational duration was 6.1 days longer in the SP group , 95 % CI ( 1.5 , 10.6 ) . In the placebo group there were two cases of urticaria and one case of nausea ; in the SP group there was one case of vomiting . No newborn showed any sign of serious SP side-effect . Two doses of SP were enough to significantly reduce the prevalence of peripheral and placental malaria parasitaemia among young nulliparous and primiparous pregnant women in Matola and Boane The impact of insecticide (permethrin)-treated bed nets ( ITNs ) on  malaria in pregnancy was studied in a rural area in western Kenya with intense perennial malaria transmission . All households in 40 of 79 villages were r and omized to receive  ITNs  by January 1997 . The ITNs were distributed in control villages two years later . Complete data on birth outcome were available on 2,754 ( 89.6 % ) of 3,072 deliveries . Women ( n = 780 ) were followed monthly throughout pregnancy in 19 of 79 villages . Among gravidae 1 - 4 , ITNs were associated with reductions of 38 % ( 95 % confidence interval [ CI ] = 17 - 54 % ) in the incidence of malaria parasitemia and 47 % ( 95 % CI = 6 - 71 % ) in the incidence of severe malarial anemia ( hemoglobin level < 8 g/dL with parasitemia ) during pregnancy . At the time of delivery , mean hemoglobin levels were 0.6 g/dL ( 95 % CI = 0.01 - 1.2 g/dL ) higher , the prevalence of placental or maternal malaria was reduced by 35 % ( 95 % CI = 20 - 47 % ) , and the prevalence of low birth weight was reduced by 28 % ( 95 % CI =  
    Output:
    
These data support the continued scale-up of these malaria prevention interventions in endemic setting s that will prevent a considerable number of child deaths due directly and indirectly to malaria