Abstract
Visceral leishmaniasis (VL) has been targeted for elimination from Southeast Asia (SEA). The disease has been endemic in SEA, and in other parts of the world involving both humans and animals. One of the key strategies for combating VL is controlling for the vector sandfly. There are a few vector control strategies that are currently in practice. We sought to assess the efficacy and community effectiveness of insecticide treated nets (ITNs) in controlling the burden of sandfly and the occurrence of VL among humans. We conducted a systematic review following a study protocol and the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria. 6331 initial hits were retrieved from Google Scholar, Lilacs, PubMed, Science Direct, WHOlis, WHOiris and PAHOiris. 25 met the full inclusion criteria. Findings show that the insecticide impregnated bednets and the commercially treated long lasting insecticidal nets (LLINs) are effective in controlling sandflies, with mortalities as high as 75% lasting over a year; although their role in controlling VL in the community was not extensively studied, since effectiveness was usually measured with sandflies densities. Findings also show that insecticide impregnated bednets are low cost and well accepted in the community, however, early erosion of insecticides from nets could occur. Some studies also showed that killing of sandflies may not translate into reduction of VL, therefore sandfly knock down and killing data needs to be interpreted with caution. Conclusions of this review are (1) combining insecticide impregnated bednets, as targeted interventions, with another vector control measure, particularly indoor residual spraying, and in conjunction with case detection, could be the way forward to controlling VL in resource limited settings. (2) Given the current low incidence of VL in SEA, it can be difficult to further research the community effectiveness of those control measures in reducing VL.
Highlights
Visceral leishmaniasis (VL), known as kala-azar, as a Neglected Tropical Disease of poverty, has been targeted for elimination from Southeast Asia (SEA) [1]
Our systematic review has demonstrated that vector control interventions involving insecticide treated nets work effectively in community settings to reduce sandfly density, their exposure to and occurrence of VL among humans in South Asian (India, Bangladesh and Nepal) settings, as well as in other regional settings including in sub-Saharan Africa (Sudan), Latin America (Brazil) and the Mediterranean region (Turkey)
It is important to consider that the effectiveness of insecticide treated nets (ITNs) and long lasting insecticidal nets (LLINs) interventions were measured with sandflies densities, which has certain level of limitations since most of the included studies did not assess VL incidence as an outcome for the intervention’s effectiveness
Summary
Visceral leishmaniasis (VL), known as kala-azar, as a Neglected Tropical Disease of poverty, has been targeted for elimination from Southeast Asia (SEA) [1]. As per a 2012 estimate, there were 200,000 to 400,000 VL cases from 79 countries and 20,000 to 40,000 deaths annually in the previous five years [3]. Eighty percent of global VL cases were reported from the South Asian eco-epidemiological hotspot comprising countries including Bangladesh, India and Nepal. More recent data show that globally 23,804 cases were reported to WHO in 2015, of which 9,249 (39%) were from the South Asian hotspot [4]. Annual cases of kala-azar in these South Asian countries declined from 77,000 cases in 1992 to fewer than 7000 in 2016 [5]. Sporadic cases are reported from the other countries in the SEA region including Bhutan, Myanmar, Sri Lanka and Thailand
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