Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Cochrane Database Syst Rev. 2022 Oct 6;10(10):CD013398. doi: 10.1002/14651858.CD013398.pub4.
Malaria remains an important public health problem. Research in 1900 suggested house modifications may reduce malaria transmission. A previous version of this review concluded that house screening may be effective in reducing malaria. This update includes data from five new studies.
To assess the effects of house modifications that aim to reduce exposure to mosquitoes on malaria disease and transmission.
We searched the Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (PubMed); Embase (OVID); Centre for Agriculture and Bioscience International (CAB) Abstracts (Web of Science); and the Latin American and Caribbean Health Science Information database (LILACS) up to 25 May 2022. We also searched the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry to identify ongoing trials up to 25 May 2022.
Randomized controlled trials, including cluster-randomized controlled trials (cRCTs), cross-over studies, and stepped-wedge designs were eligible, as were quasi-experimental trials, including controlled before-and-after studies, controlled interrupted time series, and non-randomized cross-over studies. We sought studies investigating primary construction and house modifications to existing homes reporting epidemiological outcomes (malaria case incidence, malaria infection incidence or parasite prevalence). We extracted any entomological outcomes that were also reported in these studies.
Two review authors independently selected eligible studies, extracted data, and assessed the risk of bias. We used risk ratios (RR) to compare the effect of the intervention with the control for dichotomous data. For continuous data, we presented the mean difference; and for count and rate data, we used rate ratios. We presented all results with 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach.
One RCT and six cRCTs met our inclusion criteria, with an additional six ongoing RCTs. We did not identify any eligible non-randomized studies. All included trials were conducted in sub-Saharan Africa since 2009; two randomized by household and four at the block or village level. All trials assessed screening of windows, doors, eaves, ceilings, or any combination of these; this was either alone, or in combination with roof modification or eave tube installation (an insecticidal "lure and kill" device that reduces mosquito entry whilst maintaining some airflow). In one trial, the screening material was treated with 2% permethrin insecticide. In five trials, the researchers implemented the interventions. A community-based approach was adopted in the other trial. Overall, the implementation of house modifications probably reduced malaria parasite prevalence (RR 0.68, 95% CI 0.57 to 0.82; 5 trials, 5183 participants; moderate-certainty evidence), although an inconsistent effect was observed in a subpopulation of children in one study. House modifications reduced moderate to severe anaemia prevalence (RR 0.70, 95% CI 0.55 to 0.89; 3 trials, 3643 participants; high-certainty evidence). There was no consistent effect on clinical malaria incidence, with rate ratios ranging from 0.38 to 1.62 (3 trials, 3365 participants, 4126.6 person-years). House modifications may reduce indoor mosquito density (rate ratio 0.63, 95% CI 0.30 to 1.30; 4 trials, 9894 household-nights; low-certainty evidence), although two studies showed little effect on this parameter.
AUTHORS' CONCLUSIONS: House modifications - largely screening, sometimes combined with insecticide and lure and kill devices - were associated with a reduction in malaria parasite prevalence and a reduction in people with anaemia. Findings on malaria incidence were mixed. Modifications were also associated with lower indoor adult mosquito density, but this effect was not present in some studies.
疟疾仍然是一个重要的公共卫生问题。1900 年的研究表明，房屋改造可能会降低疟疾传播。之前的一篇综述得出结论，房屋筛查可能有效降低疟疾。本更新纳入了五项新的研究。
评估旨在减少蚊子暴露的房屋改造措施对疟疾疾病和传播的影响。
我们检索了 Cochrane 传染病组专业注册库、Cochrane 图书馆中的对照试验中心注册库（CENTRAL）、PubMed 中的 MEDLINE、OVID 中的 Embase、Web of Science 中的 Centre for Agriculture and Bioscience International（CABI）文摘以及 LILACS（拉丁美洲和加勒比卫生科学信息数据库），检索时间截至 2022 年 5 月 25 日。我们还检索了世界卫生组织国际临床试验注册平台、ClinicalTrials.gov 和 ISRCTN 注册，以确定截至 2022 年 5 月 25 日正在进行的试验。
随机对照试验，包括整群随机对照试验（cRCT）、交叉研究和阶梯式楔形设计，以及准实验研究，包括对照前后研究、对照中断时间序列和非随机交叉研究，均符合入选标准。我们研究了对现有房屋进行的主要建造和房屋改造，报告了流行病学结局（疟疾病例发病率、疟疾感染发病率或寄生虫流行率）。我们还提取了这些研究中报告的任何昆虫学结局。
两名综述作者独立选择合格的研究、提取数据并评估偏倚风险。我们使用风险比（RR）比较干预组与对照组的效果。对于连续性数据，我们呈现均值差；对于计数和率数据，我们使用率比。我们使用 95%置信区间（CI）呈现所有结果。我们使用 GRADE 方法评估证据的确定性。
一项 RCT 和六项 cRCT 符合纳入标准，另有六项正在进行的 RCT。我们没有发现任何合格的非随机研究。所有纳入的试验均在 2009 年以后在撒哈拉以南非洲进行；两项随机分组按家庭进行，四项按街区或村庄进行。所有试验均评估了窗户、门、屋檐、天花板或这些组合的筛查；单独或与屋顶改造或檐管安装（一种减少蚊子进入的昆虫诱饵和杀灭装置，同时保持一定的气流）相结合。在一项试验中，筛选用的是 2%氯菊酯杀虫剂处理过的材料。在五项试验中，研究人员实施了干预措施。另一项试验采用了基于社区的方法。总的来说，房屋改造可能降低疟疾寄生虫流行率（RR 0.68，95%CI 0.57 至 0.82；5 项试验，5183 名参与者；中等确定性证据），尽管在一项研究的一个亚组人群中观察到效果不一致。房屋改造降低了中度至重度贫血的流行率（RR 0.70，95%CI 0.55 至 0.89；3 项试验，3643 名参与者；高确定性证据）。对临床疟疾发病率没有一致的影响，率比范围为 0.38 至 1.62（3 项试验，3365 名参与者，4126.6 人年）。房屋改造可能降低室内蚊子密度（RR 0.63，95%CI 0.30 至 1.30；4 项试验，9894 户家庭夜；低确定性证据），尽管两项研究显示该参数影响不大。
房屋改造 - 主要是筛查，有时结合杀虫剂和诱饵捕杀装置 - 与降低疟疾寄生虫流行率和减少贫血人数有关。疟疾发病率的研究结果不一致。改造也与室内成蚊密度降低有关，但在一些研究中没有这种效果。
