What Works for Women and Girls

stillbirths by 33%. Three cluster-randomized and two individually randomized trials,four from Africa with 6,418 pregnant women and one from Thailand with 223 pregnantwomen, were included in the meta-analysis. Some women in the cluster-randomizedtrials became pregnant after ITNs were distributed and were therefore protectedthroughout pregnancy, when the risk of malaria parasitemia is greatest. ITNs used bythe whole community results in area-wide reductions in malaria transmission (Gambleet al., 2007). (Gray I) (bednets, malaria, Africa, Thailand)A prospective cohort study in Uganda funded by PEPFAR found that co-trimoxazoleprophylaxis, antiretroviral therapy and insecticide treated bednets substantially reducedthe frequency of malaria in adults with HIV. Of 466 people living with HIV aged 18 andover, 75% were women, of whom 56 died and 11 were lost to follow-up and none receivedan intervention. Of the 399 remaining who started co-trimoxazole, 138 survived andwere clinically eligible for antiretroviral therapy and received both co-trimoxazole andantiretroviral therapy. In addition to these 138 who received both co-trimoxazole andantiretroviral therapy, an additional 897 additional people also received both co-trimoxazoleand antiretroviral therapy. Of these 1,035 people who received co-trimoxazole andantiretroviral therapy, 45 died and five moved or were lost to follow-up. The remaining985 people also received insecticide treated bednets, including four people who startedco-trimoxazole, antiretroviral therapy and received ITNs simultaneously. CD4 countswere taken when first enrolled and at regular intervals. Antiretroviral therapy was deliveredto homes in prepackaged pillboxes and pills were counted at each visit. Accordingto pill counts, 98% took at least 95% of the prescribed antiretroviral therapy. Two insecticidetreated bednets were given to all households with instructions for use. Medianfollow up before co-trimoxazole was 154 days; during co-trimoxazole and antiretroviraltherapy 126 days; and during co-trimoxazole, antiretroviral therapy and ITNs, 560 days.120,750 home visits were done. Compared with no intervention, co-trimoxazole prophylaxiswas associated with a 76% lower malaria rate (9.0 versus 50.8 episodes per 100person-years); antiretroviral therapy and co-trimoxazole with a 92% lower malaria rate;and co-trimoxazole, antiretroviral therapy and ITNs with a 95% lower malaria rate (50.8episodes per 100 person years to 2.1 episodes per 100 person years among people livingwith HIV) than during the time with no intervention of co-trimoxazole (Mermin et al.,2006). (Gray III) (treatment, bednets, malaria, Uganda)Starting in 2006, the government of Rwanda scaled up preventive and curative malariainterventions, increasing access to Artemisinin Combination Therapies (ACT) anddelivering 1.6 million ITNs in one week with an additional 1.6 million ITNs distributedby April 2009 through ANC and community health workers, reducing deaths frommalaria by 60%. Because everyone in the household received an ITN, pregnant womenwere ensured access to ITNs. Approximately 60% of pregnant women in 2007 sleptunder ITNs. Nine of ten private pharmacies now carry ACT. Between 2001 and 2005only a few hundred thousand ITNs were distributed with negligible impact (Karema,2009). (Gray V) (malaria, bednets, Rwanda)WHAT WORKS FOR WOMEN AND GIRLS281