PDF(Pubmed)
Abstract：
Malaria vectors have demonstrated resistance to pyrethroid-based insecticides used in insecticide-treated nets, diminishing their effectiveness. This systematic review and meta-analysis investigated two forms of dual active-ingredient (DAI) insecticide-treated nets (ITN(s)) for malaria prevention. A comprehensive search was conducted on July 6th 2022. The databases searched included PubMed, Embase, CINAHL, amongst others. Trials were eligible if they were conducted in a region with ongoing malaria transmission. The first DAI ITN investigated were those that combined a pyrethroid with a non-pyrethroid insecticides. The second DAI ITN investigated were that combined a pyrethroid with an insect growth regulator. These interventions were compared against either a pyrethroid-only ITN, or ITNs treated with pyrethroid and piperonyl-butoxide. Assessment of risk of bias was conducted in duplicate using the Cochrane risk of bias 2 tool for cluster-randomised trials. Summary data was extracted using a custom data-extraction instrument. This was conducted by authors THB, JCS and SH. Malaria case incidence was the primary outcome and has been meta-analysed, adverse events were narratively synthesised. The review protocol is registered on PROSPERO (CRD42022333044). From 9494 records, 48 reports were screened and 13 reports for three studies were included. These studies contained data from 186 clusters and all reported a low risk of bias. Compared to pyrethroid-only ITNs, clusters that received pyrethroid-non-pyrethroid DAI ITNs were associated with 305 fewer cases per 1000-person years (from 380 fewer cases to 216 fewer cases) (IRR = 0.55, 95%CI: 0.44-0.68). However, this trend was not observed in clusters that received pyrethroid-insect growth regulator ITNs compared to pyrethroid-only ITNs (from 280 fewer cases to 135 more) (IRR = 0.90, 95%CI: 0.73-1.13). Pyrethroid-non-pyrethroid DAI ITNs demonstrated consistent reductions in malaria case incidence and other outcomes across multiple comparisons. Pyrethroid-non-pyrethroid DAI ITNs may present a novel intervention for the control of malaria.
摘要：
疟疾病媒已证明对杀虫剂处理过的蚊帐中使用的基于拟除虫菊酯的杀虫剂具有抗性，降低其效力。这项系统评价和荟萃分析调查了两种形式的双重活性成分（DAI）杀虫剂处理过的蚊帐（ITN（s）），用于预防疟疾。2022年7月6日进行了全面搜索。搜索的数据库包括PubMed,Embase,CINAHL,在其他人中。如果试验是在疟疾持续传播的地区进行的，则符合资格。研究的第一个DAIITN是将拟除虫菊酯和非拟除虫菊酯杀虫剂结合在一起的那些。研究的第二个DAIITN是将拟除虫菊酯与昆虫生长调节剂相结合。将这些干预措施与仅有拟除虫菊酯的ITN进行比较，或用拟除虫菊酯和胡椒基丁醚处理的ITN。偏倚风险评估使用Cochrane偏倚风险2工具进行集群随机试验。使用定制数据提取仪器提取汇总数据。这是由作者THB进行的，JCS和SH。疟疾病例发生率是主要结果，并进行了荟萃分析，对不良事件进行了叙述合成.审查协议在PROSPERO(CRD42022333044)上注册。从9494条记录中，筛选了48份报告，纳入了3项研究的13份报告。这些研究包含来自186个集群的数据，并且都报告了低偏倚风险。与仅有拟除虫菊酯的ITN相比，接受拟除虫菊酯-非拟除虫菊酯DAIITN的集群与每1000人年减少305例相关(从380例减少到216例)(IRR=0.55,95CI:0.44-0.68).然而,与仅接受拟除虫菊酯的ITN相比,接受拟除虫菊酯-昆虫生长调节剂ITN的集群中未观察到这种趋势(从280例少到135例)(IRR=0.90,95CI:0.73-1.13).拟除虫菊酯-非拟除虫菊酯DAIITN在多重比较中显示出疟疾病例发病率和其他结果的持续降低。拟除虫菊酯-非拟除虫菊酯DAIITN可能为控制疟疾提供了一种新的干预措施。
