{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T14:23:48Z","timestamp":1779114228405,"version":"3.51.4"},"reference-count":107,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Insecticide-treated nets (ITNs), particularly long-lasting insecticide-treated nets (LLINs), are important for malaria control; however, the rise of insecticide resistance, behavioral adaptations in mosquito vectors, and diminishing net durability may affect their efficacy. The objective of this systematic literature review and meta-analysis to synthesize recent epidemiological evidence (2021\u20132025) on the correlation between ITN\/LLIN use and Plasmodium falciparum infection prevalence and to explore sources of heterogeneity across populations, settings, and type of nets. Searches across PubMed, Scopus, and Web of Science yielded 3151 records, of which 10 met the inclusion criteria. Two separate meta-analyses were performed for crude and adjusted effect estimates using random-effects models. The crude-effects meta-analysis included six studies comprising 7466 participants and yielded a pooled odds ratio of 0.67 (95% CI: 0.42\u20131.07; p = 0.078), indicating no statistically significant association between ITN\/LLIN use and P. falciparum infection. Significant heterogeneity was observed (I2 = 79.8%), which was partially explained by population type (59.3%) and study design (36.1%). Subgroup analysis revealed comparable infection prevalence\u2013based associations for ITNs (OR = 0.72) and LLINs (OR = 0.59) use. Assessment of publication bias indicated slight asymmetry; however, the trim-and-fill adjustment did not significantly change the conclusions. The adjusted-effects meta-analysis, comprising nine studies, yielded a non-significant pooled effect (aOR = 0.88; 95% CI: 0.42\u20131.86; p = 0.71) with substantial heterogeneity (I2 = 88.7%). Meta-regression analyses indicated that effect estimates varied by population group and country, with statistically significant modifiers observed for children under five years (p = 0.0098) and for studies conducted in Uganda (p = 0.0378). The type of net contributed to variation between studies, with insecticide-treated nets (ITNs) exhibiting lower pooled odds than long-lasting insecticide-treated nets (LLINs) (p = 0.0415). Overall, this meta-analysis found no conclusive evidence of a statistically significant association between ITN\/LLIN use and P. falciparum infection in contemporary epidemiological studies. The substantial heterogeneity across settings underscores the context-dependent nature of observed associations and highlights the need for integrated vector-control strategies and continued evaluation of net technologies under conditions of increasing resistance.<\/jats:p>","DOI":"10.3390\/tropicalmed11050137","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:36:40Z","timestamp":1779107800000},"page":"137","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Insecticide-Treated Nets on Plasmodium falciparum Infection Rates: A Meta-Analysis"],"prefix":"10.3390","volume":"11","author":[{"given":"Nevra","family":"Karaca Bi\u00e7ak\u00e7i","sequence":"first","affiliation":[{"name":"Department of Nursing, Faculty of Health Sciences, Kafkas University, Kars 36100, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ay\u015fe","family":"\u00c7almaz","sequence":"additional","affiliation":[{"name":"\u0130skilip Vocational School, Hitit University, \u00c7orum 19030, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7362-7934","authenticated-orcid":false,"given":"Merve","family":"Ayyildiz Akin","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Faculty of Veterinary Medicine, Kafkas University, Kars 36100, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5069-3314","authenticated-orcid":false,"given":"Ching Siang","family":"Tan","sequence":"additional","affiliation":[{"name":"School of Pharmacy, KPJ Healthcare University, Nilai 71800, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayanthi","family":"Barasarathi","sequence":"additional","affiliation":[{"name":"Faculty of Health & Life Sciences (FHLS), INTI International University, Nilai 71800, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babatunji E.","family":"Oyinloye","sequence":"additional","affiliation":[{"name":"Institute for Drug Research and Development, Bogoro Research Centre, Afe Babalola University, Ado-Ekiti 360001, Nigeria"},{"name":"Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa"},{"name":"Phytomedicine, Biochemical Toxicology and Biotechnology Research Laboratories, Department of Biochemistry, College of Sciences, Afe Babalola University,  Ado-Ekiti 360001, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annaev","family":"Umidjon","sequence":"additional","affiliation":[{"name":"Department of Natural Sciences, Termez University of Economics and Service, Termez 190100, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuvonchbek","family":"Egamberdiyev","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Ma\u2019mun University, Urgench 220100, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Intizor","family":"Avazmetova","sequence":"additional","affiliation":[{"name":"Department of Biology, Urgench State University, Urgench 220100, Uzbekistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/S2666-5247(21)00334-7","article-title":"Malaria progress stumbles, but new tools offer hope","volume":"3","author":"Microbe","year":"2022","journal-title":"Lancet Microbe"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"137","DOI":"10.70251\/HYJR2348.35137143","article-title":"Malaria Prevention in Africa and Beyond: A Comparative Data Analysis of Strategies and Outcomes","volume":"3","author":"Jun","year":"2025","journal-title":"Am. 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