A large-scale analysis of 25 studies from Africa and Asia found that insecticide-treated nets can reduce malaria transmission by up to 68%, but also highlighted challenges that could undermine long-term impact.
This study was published in a peer-reviewed journal infectious diseaseconfirmed that insecticide-treated nets (ITNs) continue to provide strong protection against malaria, but found that their effectiveness varies widely by region and community.
These findings suggest that the implementation of this relatively simple and low-cost intervention is under pressure, especially in areas where insecticide resistance is already established.
Researchers warn that without locally adapted control strategies that combine ITNs with other mosquito control measures, the progress made in recent decades could be at risk.
“While this study confirms that ITNs remain one of the most powerful weapons we have against malaria, it is also a warning that we cannot afford to be complacent,” says Dr. Gbeminiyi Otororin, a postdoctoral fellow at James Cook University in Australia and a veterinary public health clinician and researcher at the School of Veterinary Medicine at the University of Jos in Nigeria.
Mosquitoes are developing resistance and adapting their behavior. A tool that works well in one place may no longer work in another. We need to continually monitor, evaluate, and adjust control strategies as we strive toward global eradication of the disease. ”
Dr. Gbeminiyi Otororin, James Cook University
Malaria is a life-threatening disease caused by a parasite that is transmitted to humans through the bite of an infected mosquito. In 2024, it is estimated that there will be 282 million infections and 610,000 deaths worldwide. ITNs are one of the most widely used and cost-effective tools in malaria prevention, reducing mosquito populations and interrupting community-wide transmission while protecting individuals.
To better understand how much insecticide-treated nets actually reduce malaria illness and death, the researchers analyzed data from 25 experimental studies that compared the performance of ITNs to the use of no nets. These included 19 studies that looked at malaria incidence across eight African and four Asian countries, and six studies that assessed malaria-related deaths. Study subjects included children under 5 years of age, pregnant women, households, and entire communities, with follow-up periods ranging from 2 months to 5 years.
This finding supports the strong protective effects of ITN across these diverse environments. In Asia, ITN reduced malaria cases by 68% and malaria-related deaths by 18%. In Africa, malaria incidence has decreased by 29% to 40%.
However, the researchers also found that the effectiveness of ITN varied widely between studies, particularly in Asia. They suggest that these differences may be influenced by complex regional factors, including mosquito species diversity, patterns of insecticide resistance, and community compliance with net use.
“ITNs are undoubtedly an effective tool that has saved millions of lives and will continue to do so. However, relying on ITNs alone is not enough, especially in areas where insecticide resistance has become established,” added Dr. Otrolin, an expert in infectious disease epidemiology.
“An integrated strategy that combines networks with other interventions should now be considered essential. Otherwise, we risk losing ground in the fight against a disease that still claims hundreds of thousands of lives every year.”
The paper calls for further research to assess long-term net durability, community compliance, and insecticide resistance patterns.
“My hope is that this study will add to the existing evidence base supporting malaria control efforts and contribute to the ongoing discussion about how insecticide-treated nets can be improved, adapted and used effectively in communities where malaria prevention remains a priority,” concluded Dr. Otrolin.
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Reference magazines:
Otrolin, GR, others. (2026). Effects of insecticide-treated nets on malaria morbidity and mortality: a systematic review and meta-analysis of randomized controlled trials. infectious disease. DOI: 10.1080/23744235.2026.2666823. https://www.tandfonline.com/doi/full/10.1080/23744235.2026.2666823.
