***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: Background A prospect i ve study aim ing at assessing the effect of adding a third dose sulphadoxine-pyrimethamine ( SP ) to the st and ard  two-dose intermittent preventive treatment for pregnant women was carried out in Hounde , Burkina Faso , between March 2006 and July 2008 . Pregnant women were identified as earlier as possible during pregnancy through a network of home visitors , referred to the health facilities for inclusion and followed up until delivery . Methods Study participants were enrolled at antenatal care ( ANC ) visits and r and omized to receive either two or three doses of SP at the appropriate time . Women were visited daily and a blood slide was collected when there was fever ( body temperature > 37.5 ° C ) or history of fever . Women were encouraged to attend ANC and deliver in the health centre , where the new-born was examined and weighed . The timing and frequency of malaria infection was analysed in relation to the risk of low birth weight , maternal anaemia and perinatal mortality . Results Data on birth weight and haemoglobin were available for 1,034 women .  The incidence of malaria infections was significantly lower in women having received three instead of two doses of SP . Occurrence of first malaria infection during the first or second trimester was associated with a higher risk of low birth weight : incidence rate ratios of 3.56 ( p < 0.001 ) and 1.72 ( p = 0.034 ) , respectively . After adjusting for possible confounding factors , the risk remained significantly higher for the infection in the first trimester of pregnancy ( adjusted incidence rate ratio = 2.07 , p = 0.002 ) . The risk of maternal anaemia and perinatal mortality was not associated with the timing of first malaria infection . Conclusion Malaria infection during first trimester of pregnancy is associated to a higher risk of low birth weight . Women should be encouraged to use long-lasting insecticidal nets before and throughout their pregnancy Background This study aim ed to investigate baseline data on malaria before the evaluation of new vector control strategies in an area of pyrethroid-resistance of vectors . The burden of malaria was estimated in terms of infection ( prevalence and parasite density ) and of clinical episodes . Methods Between December 2007 and December 2008 in the health district of Ouidah - Kpomassè - Tori Bossito ( southern Benin ) , a descriptive epidemiological survey of malaria was conducted . From 28 selected villages , seven were r and omized from which a total of 440 children aged 0 to 5 years were r and omly selected . Clinical and parasitological information was obtained by active case detection of malaria episodes carried out during eight periods of six consecutive days scheduled at six weekly intervals and by cross-sectional surveys of asymptomatic infection . Entomological information was also collected . The ownership , the use and the correct use of long-lasting insecticide-treated nets ( LLINs ) were checked over weekly-survey by unannounced visits at home in the late evening . Results Mean parasite density in asymptomatic children was 586 P. falciparum asexual forms per μL of blood ( 95%CI 504 - 680 ) . Pyrogenic parasite cut-off was estimated 2,000 P. falciparum asexual blood forms per μL. The clinical incidence of malaria was 1.5 episodes per child per year ( 95%CI 1.2 - 1.9 ) . Parasitological and clinical variables did not vary with season . Anopheles gambiaes.l . was the principal vector closely followed by Anopheles funestus . Entomological inoculation rate was 5.3 ( 95%CI 1.1 - 25.9 ) infective bites per human per year . Frequency of the L1014F kdr ( West ) allele was around 50 % . Annual prevalence rate of Plasmodium falciparum asymptomatic infection was 21.8 % ( 95%CI 19.1 - 24.4 ) and increased according to age . Mean rates of ownership and use of LLINs were 92 % and 70 % respectively . The only correct use of LLINs ( 63 % ) conferred 26 % individual protection against only infection ( OR = 0.74 ( 95%IC 0.62 - 0.87 ) , p = 0.005 ) . Conclusion The health district of Ouidah-Kpomassè-Tori Bossito is a mesoendemic area with a moderate level of pyrethroid-resistance of vectors . The used LLINs rate was high and only the correct use of LLINs was found to reduce malaria infection without influencing malaria morbidity 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 Background Malaria in pregnancy ( MiP ) is a major public health problem in endemic areas of sub-Saharan Africa and has important consequences on birth outcome .Because MiP is a complex phenomenon and malaria epidemiology is rapidlychanging , additional evidence is still required to underst and how best tocontrol malaria . This study followed a prospect i ve cohort of pregnant womenwho had access to intensive malaria screening and prompt treatment  toidentify factors associated with increased risk of MiP and to analyse howvarious characteristics of MiP affect delivery outcomes . Methods Between October 2006 and May 2009 , 1,218 pregnant women were enrolled in a prospect i ve cohort . After an initial assessment , they were screened weeklyfor malaria . At delivery , blood smears were obtained from the mother , placenta , cord and newborn . Multivariate analyses were performed to analysethe association between mothers ’ characteristics and malaria risk , aswell as between MiP and birth outcome , length and weight at birth . This study is a secondary analysis of a trial registered with Clinical Trials.gov , number NCT00495508 . Results Overall , 288/1,069 ( 27 % ) mothers had 345 peripheral malaria infections . Therisk of peripheral malaria was higher in mothers who were younger , infectedwith HIV , had less education , lived in rural areas or reported no bed netuse , whereas the risk of placental infection was associated with morefrequent malaria infections and with infection during late pregnancy . Therisk of pre-term delivery and of miscarriage was increased in mothersinfected with HIV , living in rural areas and with MiP occurring within twoweeks of delivery . In adjusted analysis , birth weight but not length was reduced in babies ofmothers exposed to MiP ( −60 g , 95%CI : -120 to 0 for at least oneinfection and -150 g , 95%CI : -280 to −20 for > 1 infections ) . Conclusions In this study , the timing , parasitaemia level and number ofperipherally-detected malaria infections , but not the presence of fever , were associated with adverse birth outcomes . Hence , prompt malaria detection and treatment should be offered to pregnant women regardless of symptoms orother preventive measures used during pregnancy , and with increased focus onmothers living in remote areas Background Malaria is a leading cause of disease burden in Ug and a , although surprisingly few contemporary , age-stratified data exist on malaria epidemiology in the country . This report presents results from a total population survey of malaria infection and intervention coverage in a rural area of eastern Ug and a , with a specific focus on how risk factors differ between demographic groups in this population . Methods In 2008 , a cross-sectional survey was conducted in four contiguous villages in Mul and a , sub-county in Tororo district , eastern Ug and a , to investigate the epidemiology and risk factors of Plasmodium species infection . All permanent residents were invited to participate , with blood smears collected from 1,844 individuals aged between six months and 88 years ( representing 78 % of the population ) . Demographic , household and socio-economic characteristics were combined with environmental data using a Geographical Information System . Hierarchical models were used to explore patterns of malaria infection and identify individual , household and environmental risk factors . Results Overall , 709 individuals were infected with Plasmodium , with prevalence highest among 5 - 9 year olds ( 63.5 % ) . Thin films from a r and om sample of 20 % of parasite positive participants showed that 94.0 % of infections were Plasmodium falciparum and 6.0 % were P. malariae ; no other species or mixed infections were seen . In total , 68 % of households owned at least one mosquito although only 27 % of school-aged children reported sleeping under a net the previous night . In multivariate analysis , infection risk was highest amongst children aged 5 - 9 years and remained high in older children . Risk of infection was lower for those that reported sleeping under a bed net the previous night and living more than 750 m from a rice-growing area . After accounting for clustering within compounds , there was no evidence for an association between infection prevalence and socio-economic status , and no evidence for spatial clustering . Conclusion These findings demonstrate that mosquito net usage remains inadequate and is strongly associated with risk of malaria  among school-aged children .  Infection risk amongst adults is influenced by proximity to potential mosquito breeding grounds . Taken together , these findings emphasize the importance of increasing net coverage , especially among school-aged children Background Malaria is preventable and treatable when recommended interventions are properly implemented . Thus , diagnosis and treatment focus on symptomatic individuals while asymptomatic Plasmodium infection ( PI ) plays a role in the sustainability of the transmission and may also have an impact on the morbidity of the disease in terms of anaemia , nutritional status and even cognitive development of children . The objective of this study was to assess PI prevalence and its relationship with known morbidity factors in a vulnerable but asymptomatic stratum of the population . Methods A simple r and om sample , household survey in asymptomatic children under the age of five was conducted from April to September 2012 in two health areas of the health zone of Mont Ngafula 1 , Kinshasa , Democratic Republic of Congo . Results The PI prevalence were 30.9 % ( 95 % CI : 26.5 - 35.9 ) and 14.3 % ( 95 % CI : 10.5 - 18.1 ) in Cité Pumbu and Kindele health areas , respectively , ( OR : 2.7 ; p < 0.001 ) . All were Plasmodium falciparum infected and 4 % were co-infected with Plasmodium malariae . In Cité Pumbu and Kindele , the prevalence of anaemia ( haemoglobin < 11 g/dL ) was 61.6 % ( 95 % CI : 56.6 - 66.5 ) and 39.3 % ( 95 % CI : 34.0 - 44.6 ) , respectively , ( OR : 2.5 ; p < 0.001 ) . The health area of Cité Pumbu had 32 % ( 95 % CI : 27.5 - 37.0 ) of chronic malnutrition ( HAZ score ≤ −2SD ) compared to 5.1 % ( 95 % CI : 2.8 - 7.6 ) in Kindele . PI was predictor factor for anaemia ( aOR : 3.5 , p = 0.01 ) and within infected children , there was an inverse relationship between parasite density and haemoglobin level ( β = −5 * 10−5 , p < 0.001 ) . Age older than 12 months ( aOR : 3.8 , p = 0.01 ) , presence of anaemia ( aOR : 3.4 , p = 0.001 ) , chronic malnutrition ( aOR : 1.8 , p = 0.01 ) , having a single parent/guardian ( aOR : 1.6 , p = 0.04 ) , and the non-use of insecticide-treated nets ( aOR : 1.7 , p = 0.04 ) were all predictors for PI in the overall population . Conclusion PI in asymptomatic children was correlated with anaemia and chronic malnutrition and was thus a harmful condition in the study population 
    Output:
    
Conclusions : This review identified numerous local findings of low , non-significant PE –or even the absence of a protective effect provided by these MCIs .