Abstract
IntroductionInsecticide-treated nets (ITNs) are one of the main interventions used for malaria control. However, these nets may also be effective against other vector borne diseases (VBDs). We conducted a systematic review and meta-analysis to estimate the efficacy of ITNs, insecticide-treated curtains (ITCs) and insecticide-treated house screening (ITS) against Chagas disease, cutaneous and visceral leishmaniasis, dengue, human African trypanosomiasis, Japanese encephalitis, lymphatic filariasis and onchocerciasis.MethodsMEDLINE, EMBASE, LILACS and Tropical Disease Bulletin databases were searched using intervention, vector- and disease-specific search terms. Cluster or individually randomised controlled trials, non-randomised trials with pre- and post-intervention data and rotational design studies were included. Analysis assessed the efficacy of ITNs, ITCs or ITS versus no intervention. Meta-analysis of clinical data was performed and percentage reduction in vector density calculated.ResultsTwenty-one studies were identified which met the inclusion criteria. Meta-analysis of clinical data could only be performed for four cutaneous leishmaniasis studies which together showed a protective efficacy of ITNs of 77% (95%CI: 39%–91%). Studies of ITC and ITS against cutaneous leishmaniasis also reported significant reductions in disease incidence. Single studies reported a high protective efficacy of ITS against dengue and ITNs against Japanese encephalitis. No studies of Chagas disease, human African trypanosomiasis or onchocerciasis were identified.ConclusionThere are likely to be considerable collateral benefits of ITN roll out on cutaneous leishmaniasis where this disease is co-endemic with malaria. Due to the low number of studies identified, issues with reporting of entomological outcomes, and few studies reporting clinical outcomes, it is difficult to make strong conclusions on the effect of ITNs, ITCs or ITS on other VBDs and therefore further studies be conducted. Nonetheless, it is clear that insecticide-treated materials such as ITNs have the potential to reduce pathogen transmission and morbidity from VBDs where vectors enter houses.
Highlights
Insecticide-treated nets (ITNs) are one of the main interventions used for malaria control
Integrated Vector Management (IVM) involves the use of a range of proven vector control tools used either alone or in combination selected based on knowledge of the local vector ecology and epidemiological situation
We developed a tool for assessing study quality which primarily concerns the study design and downgrades the score given to the study depending on whether sample size calculations were performed, the length of the follow up period and risk of bias (Supporting Information S6)
Summary
Insecticide-treated nets (ITNs) are one of the main interventions used for malaria control. These nets may be effective against other vector borne diseases (VBDs). IVM can involve use of multiple vector control tools against a single disease or alternatively a single tool against multiple diseases. This is the case where vector control interventions are active against more than one disease and VBDs overlap in their distribution. In order to exploit synergies between VBDs and make vector control more cost effective, IVM advocates for the use of shared interventions across diseases.
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