Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA.
Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Lancet Glob Health. 2023 Apr;11(4):e534-e545. doi: 10.1016/S2214-109X(23)00044-X.
Humanitarian emergencies can lead to population displacement, food insecurity, severe health system disruptions, and malaria epidemics among individuals who are immunologically naive. We aimed to assess the impact of different vector control interventions on malaria disease burden during humanitarian emergencies.
In this systematic review and meta-analysis, we searched ten electronic databases and two clinical trial registries from database inception to Oct 19, 2020, with no restrictions on language or study design. We also searched grey literature from 59 stakeholders. Studies were eligible if the population was affected by a humanitarian emergency in a malaria endemic region. We included studies assessing any vector control intervention and in which the primary outcome of interest was malaria infection risk. Reviewers (LAM, JF-A, KC, BP, and LP) independently extracted information from eligible studies, without masking of author or publication, into a database. We did random-effects meta-analyses to calculate pooled risk ratios (RRs) for randomised controlled trials, odds ratios (ORs) for dichotomous outcomes, and incidence rate ratios (IRR) for clinical malaria in non-randomised studies. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This study is registered with PROSPERO, CRD42020214961.
Of 12 475 studies screened, 22 studies were eligible for inclusion in our meta-analysis. All studies were conducted between Sept 1, 1989, and Dec 31, 2018, in chronic emergencies, with 616 611 participants from nine countries, evaluating seven different vector control interventions. Insecticide-treated nets significantly decreased Plasmodium falciparum incidence (RR 0·55 [95% CI 0·37-0·79]; high certainty) and Plasmodium vivax incidence (RR 0·69 [0·51-0·94]; high certainty). Evidence for an effect of indoor residual spraying on P falciparum (IRR 0·57 [95% CI 0·53-0·61]) and P vivax (IRR 0·51 [0·49-0·52]) incidence was of very low certainty. Topical repellents were associated with reductions in malaria infection (RR 0·58 [0·35-0·97]; moderate certainty). Moderate-to-high certainty evidence for an effect of insecticide-treated chaddars (equivalent to shawls or blankets) and insecticide-treated cattle on malaria outcomes was evident in some emergency settings. There was very low certainty evidence for the effect of insecticide-treated clothing.
Study findings strengthen and support WHO policy recommendations to deploy insecticide-treated nets during chronic humanitarian emergencies. There is an urgent need to evaluate and adopt novel interventions for malaria control in the acute phase of humanitarian emergencies.
WHO Global Malaria Programme.
人道紧急情况可能导致人口流离失所、粮食不安全、严重的卫生系统中断以及免疫幼稚的个体中疟疾流行。我们旨在评估不同病媒控制干预措施对人道紧急情况下疟疾疾病负担的影响。
在这项系统评价和荟萃分析中，我们从数据库建立到 2020 年 10 月 19 日，在没有语言或研究设计限制的情况下，搜索了十个电子数据库和两个临床试验注册处。我们还从 59 个利益攸关方的灰色文献中进行了搜索。如果人群受到疟疾流行地区的人道紧急情况的影响，则符合研究条件。我们纳入了评估任何病媒控制干预措施的研究，其中主要关注的结局是疟疾感染风险。审查员（LAM、JF-A、KC、BP 和 LP）独立地将合格研究中的信息提取到数据库中，没有对作者或出版物进行掩盖。我们对随机对照试验进行了随机效应荟萃分析，以计算出疟疾感染风险的汇总风险比（RR），对二分类结局进行了优势比（OR），对非随机研究中的临床疟疾进行了发病率比（IRR）。使用评估、制定和评估建议的分级（GRADE）方法评估证据的确定性。本研究在 PROSPERO 中注册，CRD42020214961。
在筛选出的 12475 项研究中，有 22 项研究符合纳入荟萃分析的条件。所有研究均于 1989 年 9 月 1 日至 2018 年 12 月 31 日期间进行，涉及 9 个国家的 616611 名参与者，评估了 7 种不同的病媒控制干预措施。经杀虫剂处理的蚊帐可显著降低恶性疟原虫感染率（RR0.55[95%CI0.37-0.79]；高确定性）和间日疟原虫感染率（RR0.69[0.51-0.94]；高确定性）。关于室内滞留喷洒对恶性疟原虫（IRR0.57[0.53-0.61]）和间日疟原虫（IRR0.51[0.49-0.52]）发病率的影响证据的确定性非常低。局部驱虫剂与疟疾感染的减少有关（RR0.58[0.35-0.97]；中等确定性）。在某些紧急情况下，有中高度确定性证据表明，经杀虫剂处理的披肩（相当于披肩或毯子）和经杀虫剂处理的牛对疟疾结局有影响。关于经杀虫剂处理的衣物的影响，证据确定性非常低。
研究结果加强并支持世卫组织的政策建议，即在慢性人道紧急情况下部署经杀虫剂处理的蚊帐。迫切需要评估和采用新的干预措施，以在人道紧急情况的急性期控制疟疾。
世卫组织全球疟疾规划。
