***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 
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    ***EXAMPLES*** 
    Input: Background In the present study , Interceptor ® , long-lasting polyester net , 75 denier and bursting strength of minimum 250 kPa coated with alpha-cypermethrin @ 200 mg/m2 was evaluated for its efficacy in reducing the mosquito density , blood feeding inhibition and malaria incidence in a tribal dominated malaria endemic area in Chhattisgarh state , central India . Its durability , washing practice s and usage pattern by the community was also assessed up to a period of three years . Methods The study was carried out in two phases . In the first phase ( September 2006 to August 2007 ) , 16 malaria endemic villages in district Kanker were r and omized into three groups , viz . Interceptor net ( LN ) , untreated polyester net ( 100 denier ) and without net . Malaria cases were detected by undertaking fortnightly surveillance by home visits and treated as per the national drug policy . Mosquito collection s were made by h and catch and pyrethrum space spray methods from human dwellings once every month . Slide positivity rate ( SPR ) and malaria incidence per 1000 population ( PI ) were compared between the three study arms to assess the impact of use of Interceptor nets . Simultaneously , wash resistance studies were carried out in the laboratory by doing cone bioassays on Interceptor LNs washed up to 20 times . Activities undertaken in second Phase ( April 2008 to October 2009 ) after an interval of about 18 months post-net distribution included question naire based surveys at every six months , i.e. 18 , 24 , 30 and 36 months to observe durability , usage pattern of LNs and washing practice s by the community . After 36 months of field use , 30 nets were retrieved and sample d destructively for chemical analysis . Results Interceptor nets were found effective in reducing the density , parity rate and blood feeding success rate of main malaria vector Anopheles culicifacies as compared to that in untreated net and no net villages . SPR in LN villages was 3.7 % as compared to 6.5 % in untreated and 11 % in no net villages . PI in LN villages was 16.4 in comparison to 24.8 and 44.2 in untreated polyester net and no net villages respectively . In surveys carried out after three years of initial distribution , 78.7 % ( 737/936 ) nets were still in possession with the households , of which 68 % were used every night . An . culicifacies mortality was > 80 % in cone bioassays done on LNs washed up to 20 times in laboratory . Mean alpha-cypermethrin content was 43.5 ± 31.7 mg/m2 on Interceptor LNs withdrawn after three years of household use against the baseline specification of 200 mg/m2 . A gradual increase in the proportion of holed nets was observed with the increased period of usage . Conclusion Interceptor nets were highly effective in reducing vector densities as well as malaria incidence in the study villages . Availability of 78 % nets with the households in usable condition clearly indicated durability of Interceptor LNs up to three years in the rural setting of India . The nets were found to contain an effective concentration of alpha-cypermethrin against malaria vector after three years of household use Abstract Objective : To assess the impact of a social marketing programme for distributing nets treated with insecticide on malarial parasitaemia and anaemia in very young children in an area of high malaria transmission . Design : Community cross sectional study . Annual , cross sectional data were collected at the beginning of the social marketing campaign ( 1997 ) and the subsequent two years . Net ownership and other risk and confounding factors were assessed with a question naire . Blood sample s were taken from the children to assess prevalence of parasitaemia and haemoglobin levels . Setting : 18 villages in the Kilombero and Ulanga districts of southwestern Tanzania . Participants : A r and om sample of children aged under 2 years . Main outcome measures : The presence of any parasitaemia in the peripheral blood sample and the presence of anaemia ( classified as a haemoglobin level of ≤80 g/l ) . Results : Ownership of nets increased rapidly ( treated or not treated nets : from 58 % to 83 % ; treated nets : from 10 % to 61 % ) . The mean haemoglobin level rose from 80 g/l to 89 g/l in the study children in the successive surveys . Overall , the prevalence of anaemia in the study population decreased from 49 % to 26 % in the two years studied . Treated nets had a protective efficacy of 62 % ( 95 % confidence interval 38 % to 77 % ) on the prevalence of parasitaemia and of 63 % ( 27 % to 82 % ) on anaemia . Conclusions : These results show that nets treated with insecticide have a substantial impact on morbidity when distributed in a public health setting Many severe health risks in developing countries could be substantially reduced with access to appropriate preventive measures . However , the associated costs are often high enough to restrict access among poor households , and free provision through public health campaigns is often not financially feasible . We describe findings from the first large-scale cluster r and omized controlled trial in a developing country context that evaluates the uptake of a health-protecting technology , insecticide-treated bednets ( ITNs ) , through micro-consumer loans , as compared to free distribution and control conditions . Numerous studies have shown that widespread , regular use of ITNs is one the most effective preventive measures against malaria . However , ownership rates remain very low in most malarious areas , including our study areas in rural Orissa ( India ) . Despite the un-subsidized price , 52 percent of sample households purchased at least one ITN  , leading to 16 percent of individuals using a treated net the previous night , relative to only 2 percent in control areas where nets were not offered for sale . However , the increase fell significantly short of the 47 percent previous-night usage rate achieved with free distribution . Most strikingly , we find that neither micro-loans nor free distribution led to improvements in malaria and anemia prevalence , measured using blood tests . We examine and rule out several plausible explanations for this latter finding . We conjecture that insufficient ITN coverage is the most likely explanation , and discuss implication s for public health policy 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 Insecticide-treated nets ( ITNs ) are effective tools for malaria prevention and can significantly reduce severe disease and mortality due to malaria , especially among children under five in endemic areas . However , ITN coverage and use remain low and inequitable among different socio-economic groups in sub-Saharan Africa , particularly in Nigeria . Several strategies have been proposed to increase coverage and use and reduce inequity in Nigeria , including free distribution campaigns recently conducted by the Nigerian federal government . Using data from the first post-campaign survey , the authors investigated the effect of the mass free distribution campaigns in achieving equity in household ownership and use of ITNs . Methods A post-campaign survey was undertaken in November 2009 in northern Nigeria to assess the effect of the campaigns in addressing equity across different socio-economic groups . The survey included 987 households r and omly selected from 60 clusters in Kano state . Using logistic regression and the Lorenz concentration curve and index , the authors assessed equity in ITN coverage and use . Results ITN ownership coverage increased from 10 % before the campaigns to 70%-a more than fivefold increase . The campaigns reduced the ownership coverage gap by 75 % , effectively reaching parity among wealth quintiles ( Concentration index 0.02 , 95 % CI ( -0.02 ; 0.05 ) versus 0.21 95%CI ( 0.08 ; 0.34 ) before the campaigns ) . ITN use ( individuals reporting having slept under an ITN the night before the survey visit ) among individuals from households owning at least one ITN , was 53.1 % with no statistically significant difference between the lowest , second , third and fourth wealth quintiles and the highest wealth quintile ( lowest : odds ratio ( OR ) 0.87 , 95 % confidence interval ( CI ) ( 0.67 ; 1.13 ) ; second : OR 0.85 , 95 % CI ( 0.66 ; 1.24 ) ; third : OR 1.10 95 % CI ( 0.86 ; 1.4 ) and fourth OR 0.91 95 % CI ( 0.72 ; 1.15 ) . Conclusion The campaign had a significant impact by increasing ITN coverage and reducing inequity in ownership and use .  Free ITN distribution campaigns should be sustained to increase equitable coverage . These campaigns should be supplemented with other ITN distribution strategies to cover newborns and replace aging nets 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 % Background Mosquito coils are the most commonly used household insecticidal product in the world with sales exceeding 50 billion coils , used by two billion people worldwide annually . Despite strong evidence that coils prevent mosquito bites a systematic review concluded that there is no evidence that burning mosquito coils prevents malaria acquisition . Therefore , the current trial was design ed to measure and compare prevention of malaria infection by mosquito coils or long-lasting insecticidal net ( LLIN ) or a combination of the two in Yunnan , China in the Greater Mekong sub-region . Methods A four-arm single blind household-r and omized design was chosen as coils emanate insecticide throughout the household . Households enrolled at baseline were r and omly allocated by the lottery method to one of the four intervention arms : ( i ) nothing , ( ii ) 0.03 % transfluthrin coils alone , ( iii ) deltamethrin long-lasting insecticide treated nets , ( LLINs ) alone or ( iv ) a combination of transfluthrin coils and deltamethrin LLINs .  All household members were recruited to the study , with only those households excluded with pregnant or breastfeeding mothers , members with chest complaints or allergies or members that regularly slept away from home . The main outcome of interest was Plasmodium falciparum malaria prevalence detected by rapid diagnostic tests ( RDTs ) during six repeated monthly cross-sectional surveys . The secondary outcome of interest was the effect on Plasmodium vivax prevalence detected in the same way . Results A total of 2,052 households were recruited into the study , comprising 7,341 individuals The odds ratios of testing positive by RDT with P. falciparum or P. vivax were > 75 % lower for all intervention arms compared with the control arm . Coils alone provided 77 % protection ( 95 % CI : 50%-89 % ) , LLINs provided 91 % protection ( 95 % CI : 72%-97 % ) and the combination of coils and LLINs provided 94 % protection ( 95 % CI : 77%-99 % ) against P. falciparum compared with the control arm . There was no statistically significant difference between the protective efficacies of the different interventions . Conclusions This is the first robust clinical evaluation of transfluthrin mosquito coils as a means to reduce malaria and the high degree of infection prevented would indicate they represent a potentially highly effective tool , which could be integrated into larger vector control programmes . Trial registration Clinical Trials.gov Identifier : NCT00442442 , March 2007 Background Relatively few programmes have attempted to actively engage the private sector in national malaria control efforts . This paper evaluates the health impact of a large-scale distribution of insecticide-treated nets ( ITNs ) conducted in partnership with a Zambian agribusiness , and its cost-effectiveness from the perspective of the National Malaria Control Programme ( NMCP ) . Methods The study was design ed as a cluster-r and omized controlled trial . A list of 81,597 cotton farmers was obtained from Dunavant , a contract farming company in Zambia ’s cotton sector , in December 201 
    Output:
    
A meta-regression model confirms that LLINs are significantly more effective than ITNs in the prevention of malaria , when controlling for other covariates .
For both types of nets , protective efficacy was greater in high transmission areas when nets were used for an extended period .
However , cross-sectional studies may overestimate the effect of the nets .
The results surprisingly suggest that nets are less effective in protecting children under the age of five , which may be due to differences in child behavior or inadequate coverage .
Compared to a previous meta- analysis , insecticide-treated nets appear to have improved their efficacy despite the risks of insecticide resistance .