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Stasolla F, Akbar K, Passaro A, Dragone M, Di Gioia M, Zullo A. Integrating reinforcement learning and serious games to support people with rare genetic diseases and neurodevelopmental disorders: outcomes on parents and caregivers. Front Psychol 2024; 15:1372769. [PMID: 38646123 PMCID: PMC11026657 DOI: 10.3389/fpsyg.2024.1372769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/05/2024] [Indexed: 04/23/2024] Open
Affiliation(s)
| | - Khalida Akbar
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
- MANCOSA, Research Doctorate, Durban, South Africa
| | - Anna Passaro
- University “Giustino Fortunato”, Benevento, Italy
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Zhou G, Githure J, Lee MC, Zhong D, Wang X, Atieli H, Githeko AK, Kazura J, Yan G. Malaria transmission heterogeneity in different eco-epidemiological areas of western Kenya: a region-wide observational and risk classification study for adaptive intervention planning. Malar J 2024; 23:74. [PMID: 38475793 PMCID: PMC10935946 DOI: 10.1186/s12936-024-04903-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Understanding of malaria ecology is a prerequisite for designing locally adapted control strategies in resource-limited settings. The aim of this study was to utilize the spatial heterogeneity in malaria transmission for the designing of adaptive interventions. METHODS Field collections of clinical malaria incidence, asymptomatic Plasmodium infection, and malaria vector data were conducted from 108 randomly selected clusters which covered different landscape settings including irrigated farming, seasonal flooding area, lowland dryland farming, and highlands in western Kenya. Spatial heterogeneity of malaria was analyzed and classified into different eco-epidemiological zones. RESULTS There was strong heterogeneity and detected hot/cold spots in clinical malaria incidence, Plasmodium prevalence, and vector abundance. The study area was classified into four zones based on clinical malaria incidence, parasite prevalence, vector density, and altitude. The two irrigated zones have either the highest malaria incidence, parasite prevalence, or the highest malaria vector density; the highlands have the lowest vector density and parasite prevalence; and the dryland and flooding area have the average clinical malaria incidence, parasite prevalence and vector density. Different zones have different vector species, species compositions and predominant species. Both indoor and outdoor transmission may have contributed to the malaria transmission in the area. Anopheles gambiae sensu stricto (s.s.), Anopheles arabiensis, Anopheles funestus s.s., and Anopheles leesoni had similar human blood index and malaria parasite sporozoite rate. CONCLUSION The multi-transmission-indicator-based eco-epidemiological zone classifications will be helpful for making decisions on locally adapted malaria interventions.
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Affiliation(s)
- Guofa Zhou
- Program in Public Health, University of California, Irvine, CA, USA.
| | - John Githure
- Sub-Saharan International Center of Excellence for Malaria Research, Tom Mboya University, Homa Bay, Kenya
| | - Ming-Chieh Lee
- Program in Public Health, University of California, Irvine, CA, USA
| | - Daibin Zhong
- Program in Public Health, University of California, Irvine, CA, USA
| | - Xiaoming Wang
- Program in Public Health, University of California, Irvine, CA, USA
| | - Harrysone Atieli
- Sub-Saharan International Center of Excellence for Malaria Research, Tom Mboya University, Homa Bay, Kenya
| | - Andrew K Githeko
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - James Kazura
- Center for Global Health and Diseases, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Guiyun Yan
- Program in Public Health, University of California, Irvine, CA, USA
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Otambo WO, Ochwedo KO, Omondi CJ, Lee MC, Wang C, Atieli H, Githeko AK, Zhou G, Kazura J, Githure J, Yan G. Community case management of malaria in Western Kenya: performance of community health volunteers in active malaria case surveillance. Malar J 2023; 22:83. [PMID: 36890544 PMCID: PMC9993668 DOI: 10.1186/s12936-023-04523-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND In western Kenya, not all malaria cases are reported as stipulated in the community case management of malaria (CCMm) strategy. This underreporting affects the equity distribution of malaria commodities and the evaluation of interventions. The current study aimed to evaluate the effectiveness of community health volunteers' active case detection and management of malaria in western Kenya. METHODS Cross-sectional active case detection (ACD) of malaria survey was carried out between May and August 2021 in three eco-epidemiologically distinct zones in Kisumu, western Kenya: Kano Plains, Lowland lakeshore and Highland Plateau. The CHVs conducted biweekly ACD of malaria household visits to interview and examine residents for febrile illness. The Community Health Volunteers (CHVs) performance during the ACD of malaria was observed and interviews done using structured questionnaires. RESULTS Of the total 28,800 surveyed, 2597 (9%) had fever and associated malaria symptoms. Eco-epidemiological zones, gender, age group, axillary body temperature, bed net use, travel history, and survey month all had a significant association with malaria febrile illness (p < 0.05). The qualification of the CHV had a significant influence on the quality of their service. The number of health trainings received by the CHVs was significantly related to the correctness of using job aid (χ2 = 6.261, df = 1, p = 0.012) and safety procedures during the ACD activity (χ2 = 4.114, df = 1, p = 0.043). Male CHVs were more likely than female CHVs to correctly refer RDT-negative febrile residents to a health facility for further treatment (OR = 3.94, 95% CI = 1.85-5.44, p < 0.0001). Most of RDT-negative febrile residents who were correctly referred to the health facility came from the clusters with a CHV having 10 years of experience or more (OR = 1.29, 95% CI = 1.05-1.57, p = 0.016). Febrile residents in clusters managed by CHVs with more than 10 years of experience (OR = 1.82, 95% CI = 1.43-2.31, p < 0.0001), who had a secondary education (OR = 1.53, 95% CI = 1.27-1.85, p < 0.0001), and were over the age of 50 (OR = 1.44, 95% CI = 1.18-1.76, p < 0.0001), were more likely to seek malaria treatment in public hospitals. All RDT positive febrile residents were given anti-malarial by the CHVs, and RDT negatives were referred to the nearest health facility for further treatment. CONCLUSIONS The CHV's years of experience, education level, and age had a significant influence on their service quality. Understanding the qualifications of CHVs can assist healthcare systems and policymakers in designing effective interventions that assist CHVs in providing high-quality services to their communities.
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Affiliation(s)
- Wilfred Ouma Otambo
- International Centre of Excellence for Malaria Research, Tom Mboya University, University of California Irvine Joint Lab, Homa Bay, Kenya
| | - Kevin O. Ochwedo
- International Centre of Excellence for Malaria Research, Tom Mboya University, University of California Irvine Joint Lab, Homa Bay, Kenya
| | - Collince J. Omondi
- International Centre of Excellence for Malaria Research, Tom Mboya University, University of California Irvine Joint Lab, Homa Bay, Kenya
| | - Ming-Chieh Lee
- Program in Public Health, University of California Irvine, Irvine, CA USA
| | - Chloe Wang
- Program in Public Health, University of California Irvine, Irvine, CA USA
| | - Harrysone Atieli
- International Centre of Excellence for Malaria Research, Tom Mboya University, University of California Irvine Joint Lab, Homa Bay, Kenya
| | - Andew K. Githeko
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Guofa Zhou
- Program in Public Health, University of California Irvine, Irvine, CA USA
| | - James Kazura
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - John Githure
- International Centre of Excellence for Malaria Research, Tom Mboya University, University of California Irvine Joint Lab, Homa Bay, Kenya
| | - Guiyun Yan
- Program in Public Health, University of California Irvine, Irvine, CA USA
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Wang X, Chakraborty B. The Sequential Multiple Assignment Randomized Trial for Controlling Infectious Diseases: A Review of Recent Developments. Am J Public Health 2023; 113:49-59. [PMID: 36516390 PMCID: PMC9755933 DOI: 10.2105/ajph.2022.307135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Infectious diseases have posed severe threats to public health across the world. Effective prevention and control of infectious diseases in the long term requires adapting interventions based on epidemiological evidence. The sequential multiple assignment randomized trial (SMART) is a multistage randomized trial that can provide valid evidence of when and how to adapt interventions for controlling infectious diseases based on evolving epidemiological evidence. We review recent developments in SMARTs to bring wider attention to the potential benefits of employing SMARTs in constructing effective adaptive interventions for controlling infectious diseases and other threats to public health. We discuss 2 example SMARTs for infectious diseases and summarize recent developments in SMARTs from the varied aspects of design, analysis, cost, and ethics. Public health investigators are encouraged to familiarize themselves with the related materials we discuss and collaborate with experts in SMARTs to translate the methodological developments into preeminent public health research. (Am J Public Health. 2023;113(1):49-59. https://doi.org/10.2105/AJPH.2022.307135).
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Affiliation(s)
- Xinru Wang
- Xinru Wang and Bibhas Chakraborty are with the Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore. Bibhas Chakraborty is also with the Department of Statistics and Data Science, National University of Singapore, Singapore
| | - Bibhas Chakraborty
- Xinru Wang and Bibhas Chakraborty are with the Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore. Bibhas Chakraborty is also with the Department of Statistics and Data Science, National University of Singapore, Singapore
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Seewald NJ. Adaptive Interventions for a Dynamic and Responsive Public Health Approach. Am J Public Health 2023; 113:37-39. [PMID: 36516392 PMCID: PMC9755934 DOI: 10.2105/ajph.2022.307157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Nicholas J Seewald
- Nicholas J. Seewald is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Martello E, Yogeswaran G, Reithinger R, Leonardi-Bee J. Mosquito aquatic habitat modification and manipulation interventions to control malaria. Cochrane Database Syst Rev 2022; 11:CD008923. [PMID: 36367444 PMCID: PMC9651131 DOI: 10.1002/14651858.cd008923.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Larval source management (LSM) may help reduce Plasmodium parasite transmission in malaria-endemic areas. LSM approaches include habitat modification (permanently or temporarily reducing mosquito breeding aquatic habitats); habitat manipulation (temporary or recurrent change to environment); or use of chemical (e.g. larviciding) or biological agents (e.g. natural predators) to breeding sites. We examined the effectiveness of habitat modification or manipulation (or both), with and without larviciding. This is an update of a review published in 2013. OBJECTIVES 1. To describe and summarize the interventions on mosquito aquatic habitat modification or mosquito aquatic habitat manipulation, or both, on malaria control. 2. To evaluate the beneficial and harmful effects of mosquito aquatic habitat modification or mosquito aquatic habitat manipulation, or both, on malaria control. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was from January 2012 to 30 November 2021. SELECTION CRITERIA Randomized controlled trials (RCT) and non-randomized intervention studies comparing mosquito aquatic habitat modification or manipulation (or both) to no treatment or another active intervention. We also included uncontrolled before-after (BA) studies, but only described and summarized the interventions from studies with these designs. Primary outcomes were clinical malaria incidence, malaria parasite prevalence, and malaria parasitaemia incidence. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. We assessed risk of bias using the Cochrane RoB 2 tool for RCTs and the ROBINS-I tool for non-randomized intervention studies. We used a narrative synthesis approach to systematically describe and summarize all the interventions included within the review, categorized by the type of intervention (habitat modification, habitat manipulation, combination of habitat modification and manipulation). Our primary outcomes were 1. clinical malaria incidence; 2. malaria parasite prevalence; and 3. malaria parasitaemia incidence. Our secondary outcomes were 1. incidence of severe malaria; 2. anaemia prevalence; 3. mean haemoglobin levels; 4. mortality rate due to malaria; 5. hospital admissions for malaria; 6. density of immature mosquitoes; 7. density of adult mosquitoes; 8. sporozoite rate; 9. entomological inoculation rate; and 10. HARMS We used the GRADE approach to assess the certainty of the evidence for each type of intervention. MAIN RESULTS Sixteen studies met the inclusion criteria. Six used an RCT design, six used a controlled before-after (CBA) study design, three used a non-randomized controlled design, and one used an uncontrolled BA study design. Eleven studies were conducted in Africa and five in Asia. Five studies reported epidemiological outcomes and 15 studies reported entomological outcomes. None of the included studies reported on the environmental impacts associated with the intervention. For risk of bias, all trials had some concerns and other designs ranging from moderate to critical. Ten studies assessed habitat manipulation (temporary change to the environment). This included water management (spillways across streams; floodgates; intermittent flooding; different drawdown rates of water; different flooding and draining regimens), shading management (shading of drainage channels with different plants), other/combined management approaches (minimal tillage; disturbance of aquatic habitats with grass clearing and water replenishment), which showed mixed results for entomological outcomes. Spillways across streams, faster drawdown rates of water, shading drainage canals with Napier grass, and using minimal tillage may reduce the density of immature mosquitoes (range of effects from 95% reduction to 1.7 times increase; low-certainty evidence), and spillways across streams may reduce densities of adult mosquitoes compared to no intervention (low-certainty evidence). However, the effect of habitat manipulation on malaria parasite prevalence and clinical malaria incidence is uncertain (very low-certainty evidence). Two studies assessed habitat manipulation with larviciding. This included reducing or removal of habitat sites; and drain cleaning, grass cutting, and minor repairs. It is uncertain whether drain cleaning, grass cutting, and minor repairs reduces malaria parasite prevalence compared to no intervention (odds ratio 0.59, 95% confidence interval (CI) 0.42 to 0.83; very low-certainty evidence). Two studies assessed combination of habitat manipulation and permanent change (habitat modification). This included drainage canals, filling, and planting of papyrus and other reeds for shading near dams; and drainage of canals, removal of debris, land levelling, and filling ditches. Studies did not report on epidemiological outcomes, but entomological outcomes suggest that such activities may reduce the density of adult mosquitoes compared to no intervention (relative risk reduction 0.49, 95% CI 0.47 to 0.50; low-certainty evidence), and preventing water stagnating using drainage of canals, removal of debris, land levelling, and filling ditches may reduce the density of immature mosquitoes compared to no intervention (ranged from 10% to 55% reductions; low-certainty evidence). Three studies assessed combining manipulation and modification with larviciding. This included filling or drainage of water bodies; filling, draining, or elimination of rain pools and puddles at water supply points and stream bed pools; and shoreline work, improvement and maintenance to drainage, clearing vegetation and undergrowth, and filling pools. There were mixed effect sizes for the reduction of entomological outcomes (moderate-certainty evidence). However, filling or draining water bodies probably makes little or no difference to malaria parasite prevalence, haemoglobin levels, or entomological inoculation rate when delivered with larviciding compared to no intervention (moderate-certainty evidence). AUTHORS' CONCLUSIONS Habitat modification and manipulation interventions for preventing malaria has some indication of benefit in both epidemiological and entomological outcomes. While the data are quite mixed and further studies could help improve the knowledge base, these varied approaches may be useful in some circumstances.
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Affiliation(s)
- Elisa Martello
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, Clinical Sciences Building Phase 2, University of Nottingham, Nottingham, UK
| | - Gowsika Yogeswaran
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, Clinical Sciences Building Phase 2, University of Nottingham, Nottingham, UK
| | | | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, Clinical Sciences Building Phase 2, University of Nottingham, Nottingham, UK
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Githure JI, Yewhalaw D, Atieli H, Hemming-Schroeder E, Lee MC, Wang X, Zhou G, Zhong D, King CL, Dent A, Mukabana WR, Degefa T, Hsu K, Githeko AK, Okomo G, Dayo L, Tushune K, Omondi CO, Taffese HS, Kazura JW, Yan G. Enhancing Malaria Research, Surveillance, and Control in Endemic Areas of Kenya and Ethiopia. Am J Trop Med Hyg 2022; 107:14-20. [PMID: 36228905 PMCID: PMC9662210 DOI: 10.4269/ajtmh.21-1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/18/2022] [Indexed: 01/27/2023] Open
Abstract
Malaria control programs in Africa encounter daunting challenges that hinder progressive steps toward elimination of the disease. These challenges include widespread insecticide resistance in mosquito vectors, increasing outdoor malaria transmission, lack of vector surveillance and control tools suitable for outdoor biting vectors, weakness in malaria surveillance, and an inadequate number of skilled healthcare personnel. Ecological and epidemiological changes induced by environmental modifications resulting from water resource development projects pose additional barriers to malaria control. Cognizant of these challenges, our International Center of Excellence for Malaria Research (ICEMR) works in close collaboration with relevant government ministries and agencies to align its research efforts with the objectives and strategies of the national malaria control and elimination programs for the benefit of local communities. Our overall goal is to assess the impact of water resource development projects, shifting agricultural practices, and vector interventions on Plasmodium falciparum and P. vivax malaria in Kenya and Ethiopia. From 2017 to date, the ICEMR has advanced knowledge of malaria epidemiology, transmission, immunology, and pathogenesis, and developed tools to enhance vector surveillance and control, improved clinical malaria surveillance and diagnostic methods, and strengthened the capacity of local healthcare providers. Research findings from the ICEMR will inform health policy and strategic planning by ministries of health in their quest to sustain malaria control and achieve elimination goals.
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Affiliation(s)
| | - Delenasaw Yewhalaw
- Department of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia;,Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia
| | - Harrysone Atieli
- School of Public Health and Community Development, Maseno University, Kisumu, Kenya
| | | | - Ming-Chieh Lee
- Program in Public Health, University of California at Irvine, Irvine, California
| | - Xiaoming Wang
- Program in Public Health, University of California at Irvine, Irvine, California
| | - Guofa Zhou
- Program in Public Health, University of California at Irvine, Irvine, California
| | - Daibin Zhong
- Program in Public Health, University of California at Irvine, Irvine, California
| | - Christopher L. King
- Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Arlene Dent
- Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio
| | | | - Teshome Degefa
- Department of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kuolin Hsu
- Center for Hydrometeorology and Remote Sensing, Department of Civil and Environmental Engineering, University of California at Irvine, Irvine, California
| | - Andrew K. Githeko
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Gordon Okomo
- Ministry of Health, Homa Bay County, Homa Bay, Kenya
| | - Lilyana Dayo
- Ministry of Health, Kisumu County, Kisumu, Kenya
| | - Kora Tushune
- Department of Health Management and Policy, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | | | - Hiwot S. Taffese
- National Malaria Program, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - James W. Kazura
- Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio;,Address correspondence to Guiyun Yan, Program in Public Health, University of California at Irvine, Irvine, CA, E-mail: or James Kazura, Center for Global Health & Diseases, Case Western Reserve University, Cleveland, OH, E-mail:
| | - Guiyun Yan
- Program in Public Health, University of California at Irvine, Irvine, California;,Address correspondence to Guiyun Yan, Program in Public Health, University of California at Irvine, Irvine, CA, E-mail: or James Kazura, Center for Global Health & Diseases, Case Western Reserve University, Cleveland, OH, E-mail:
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Pryce J, Medley N, Choi L. Indoor residual spraying for preventing malaria in communities using insecticide-treated nets. Cochrane Database Syst Rev 2022; 1:CD012688. [PMID: 35038163 PMCID: PMC8763033 DOI: 10.1002/14651858.cd012688.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are used to prevent malaria transmission. Both interventions use insecticides to kill mosquitoes that bite and rest indoors. Adding IRS to ITNs may improve malaria control simply because two interventions can be better than one. Furthermore, IRS may improve malaria control where ITNs are failing due to insecticide resistance. Pyrethroid insecticides are the predominant class of insecticide used for ITNs, as they are more safe than other insecticide classes when in prolonged contact with human skin. While many mosquito populations have developed some resistance to pyrethroid insecticides, a wider range of insecticides can be used for IRS. This review is an update of the previous Cochrane 2019 edition. OBJECTIVES To summarize the effect on malaria of additionally implementing IRS, using non-pyrethroid-like or pyrethroid-like insecticides, in communities currently using ITNs. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; CENTRAL; MEDLINE; and five other databases for records from 1 January 2000 to 8 November 2021, on the basis that ITN programmes did not begin to be implemented as policy before the year 2000. SELECTION CRITERIA We included cluster-randomized controlled trials (cRCTs), interrupted time series (ITS), or controlled before-after studies (CBAs) comparing IRS plus ITNs with ITNs alone. We included studies with at least 50% ITN ownership (defined as the proportion of households owning one or more ITN) in both study arms. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for eligibility, analyzed risk of bias, and extracted data. We used risk ratio (RR) and 95% confidence intervals (CI). We stratified by type of insecticide, 'pyrethroid-like' and 'non-pyrethroid-like'; the latter could improve malaria control better than adding IRS insecticides that have the same way of working as the insecticide on ITNs ('pyrethroid-like'). We used subgroup analysis of ITN usage in the studies to explore heterogeneity. We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS Eight cRCTs (10 comparisons), one CBA, and one ITS study, all conducted since 2008 in sub-Saharan Africa, met our inclusion criteria. The primary vectors in all sites were mosquitoes belonging to the Anopheles gambiae s.l. complex species; five studies in Benin, Mozambique, Ghana, Sudan, and Tanzania also reported the vector Anopheles funestus. Five cRCTs and both quasi-experimental design studies used insecticides with targets different to pyrethroids (two used bendiocarb, three used pirimiphos-methyl, and one used propoxur. Each of these studies were conducted in areas where the vectors were described as resistant or highly resistant to pyrethroids. Two cRCTs used dichloro-diphenyl-trichlorethane (DDT), an insecticide with the same target as pyrethroids. The remaining cRCT used both types of insecticide (pyrethroid deltamethrin in the first year, switching to bendiocarb for the second year). Indoor residual spraying using 'non-pyrethroid-like' insecticides Six studies were included (four cRCTs, one CBA, and one ITS). Our main analysis for prevalence excluded a study at high risk of bias due to repeated sampling of the same population. This risk did not apply to other outcomes. Overall, the addition of IRS reduced malaria parasite prevalence (RR 0.61, 95% CI 0.42 to 0.88; 4 cRCTs, 16,394 participants; high-certainty evidence). IRS may also reduce malaria incidence on average (rate ratio 0.86, 95% CI 0.61 to 1.23; 4 cRCTs, 323,631 child-years; low-certainty evidence) but the effect was absent in two studies. Subgroup analyses did not explain the qualitative heterogeneity between studies. One cRCT reported no effect on malaria incidence or parasite prevalence in the first year, when a pyrethroid-like insecticide was used for IRS, but showed an effect on both outcomes in the second year, when a non-pyrethroid-like IRS was used. The addition of IRS may also reduce anaemia prevalence (RR 0.71, 95% CI 0.38 to 1.31; 3 cRCTs, 4288 participants; low-certainty evidence). Four cRCTs reported the impact of IRS on entomological inoculation rate (EIR), with variable results; overall, we do not know if IRS had any effect on the EIR in communities using ITNs (very low-certainty evidence). Studies also reported the adult mosquito density and the sporozoite rate, but we could not summarize or pool these entomological outcomes due to differences in the reported data. Three studies measured the prevalence of pyrethroid resistance before and after IRS being introduced: there was no difference detected, but these data are limited. Indoor residual spraying using 'pyrethroid-like' insecticides Adding IRS using a pyrethroid-like insecticide did not appear to markedly alter malaria incidence (rate ratio 1.07, 95% CI 0.80 to 1.43; 2 cRCTs, 15,717 child-years; moderate-certainty evidence), parasite prevalence (RR 1.11, 95% CI 0.86 to 1.44; 3 cRCTs, 10,820 participants; moderate-certainty evidence), or anaemia prevalence (RR 1.12, 95% CI 0.89 to 1.40; 1 cRCT, 4186 participants; low-certainty evidence). Data on EIR were limited so no conclusion was made (very low-certainty evidence). AUTHORS' CONCLUSIONS in communities using ITNs, the addition of IRS with 'non-pyrethroid-like' insecticides was associated with reduced malaria prevalence. Malaria incidence may also be reduced on average, but there was unexplained qualitative heterogeneity, and the effect may therefore not be observed in all settings. When using 'pyrethroid-like' insecticides, there was no detectable additional benefit of IRS in communities using ITNs.
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Affiliation(s)
- Joseph Pryce
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nancy Medley
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Leslie Choi
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
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