Editing Malaria (section)

====Insecticide-treated nets====
[[File:Mosquitonet149.jpg|thumb|A mosquito net in use]]

Mosquito nets help keep mosquitoes away from people and reduce infection rates and transmission of malaria. Nets are not a perfect barrier and are often treated with an insecticide designed to kill the mosquito before it has time to find a way past the net. Insecticide-treated nets (ITNs) are estimated to be twice as effective as untreated nets and offer greater than 70% protection compared with no net.<ref name="Raghavendra-2011" /> Between 2000 and 2008, the use of ITNs saved the lives of an estimated 250,000 infants in Sub-Saharan Africa.<ref name="Howitt-2012" /> According to UNICEF, only 36% of households had sufficient ITNs for all household members in 2019.<ref name="UNICEF DATA">{{cite web |title=Malaria in Africa |url=https://data.unicef.org/topic/child-health/malaria/ |access-date=2023-10-31 |website=UNICEF DATA |language=en-US |archive-date=2023-11-05 |archive-url=https://web.archive.org/web/20231105153727/https://data.unicef.org/topic/child-health/malaria/ |url-status=live }}</ref> In 2000, 1.7&nbsp;million (1.8%) African children living in areas of the world where malaria is common were protected by an ITN. That number increased to 20.3&nbsp;million (18.5%) African children using ITNs in 2007, leaving 89.6&nbsp;million children unprotected<ref name="Noor-2009" /> and to 68% African children using mosquito nets in 2015.<ref name="UNICEF-2015" /> The percentage of children sleeping under ITNs in sub-Saharan Africa increased from less than 40% in 2011 to over 50% in 2021.<ref name="UNICEF DATA-2" /> Most nets are impregnated with [[pyrethroid]]s, a class of insecticides with low [[toxicity]]. They are most effective when used from dusk to dawn.<ref>{{harvnb|Schlagenhauf-Lawlor|2008|p=[https://books.google.com/books?id=54Dza0UHyngC&pg=PA215 215]}}</ref> It is recommended to hang a large "bed net" above the center of a bed and either tuck the edges under the mattress or make sure it is large enough such that it touches the ground.<ref>{{cite book |title=Instructions for treatment and use of insecticide-treated mosquito nets |date=2002 |publisher=World Health Organization |hdl=10665/67573 |hdl-access=free |page=34 }}</ref> ITNs are beneficial towards pregnancy outcomes in malaria-endemic regions in Africa but more data is needed in Asia and Latin America.<ref>{{cite journal | vauthors = Gamble C, Ekwaru JP, ter Kuile FO | title = Insecticide-treated nets for preventing malaria in pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2006 | issue = 2 | pages = CD003755 | date = April 2006 | pmid = 16625591 | pmc = 6532581 | doi = 10.1002/14651858.CD003755.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref>

In areas of high malaria resistance, piperonyl butoxide (PBO) combined with pyrethroids in mosquito netting is effective in reducing malaria infection rates.<ref name="Gleave-2021">{{cite journal | vauthors = Gleave K, Lissenden N, Chaplin M, Choi L, Ranson H | title = Piperonyl butoxide (PBO) combined with pyrethroids in insecticide-treated nets to prevent malaria in Africa | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | pages = CD012776 | date = May 2021 | pmid = 34027998 | pmc = 8142305 | doi = 10.1002/14651858.CD012776.pub3 }}</ref>  Questions remain concerning the durability of PBO on nets as the effect on mosquito mortality was not sustained after twenty washes in experimental trials.<ref name="Gleave-2021" />

UNICEF notes that the use of insecticide-treated nets has been increased since 2000 through accelerated production, procurement and delivery, stating that "over 2.5 billion ITNs have been distributed globally since 2004, with 87% (2.2 billion) distributed in sub-Saharan Africa. In 2021, manufacturers delivered about 220 million ITNs to malaria endemic countries, a decrease of 9 million ITNs compared with 2020 and 33 million less than were delivered in 2019".<ref name="UNICEF-2023"/> As of 2021, 66% of households in sub-Saharan Africa had ITNs, with figures "ranging from 31 per cent in Angola in 2016 to approximately 97 per cent in Guinea-Bissau in 2019".<ref name="UNICEF-2023"/> Slightly more than half of the households with an ITN had enough of them to protect all members of the household, however.<ref name="UNICEF-2023"/>