Randomized trials of housing interventions to prevent malaria and Aedes-transmitted diseases: A systematic review and meta-analysis.
Randomized trials of housing interventions to prevent malaria and Aedes-transmitted diseases: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0244284
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Lee SWH
中科院分区：
文献类型：
--
作者：
Kua KP;Lee SWH
蚊子传播的疾病仍然是热带地区的一个重大公共卫生问题。住房改善，如门窗筛查，可能有效地减少疾病传播，但其影响仍不清楚。研究住房干预措施是否能有效降低家中蚊子密度，以及对蚊媒疾病发病率的影响。在本系统性综述和荟萃分析中，我们检索了16个在线数据库，包括NIH PubMed、CINAHL Complete、LILACS、奥维德MEDLINE和科克伦对照试验中心注册库，以获得从数据库成立到2020年6月30日发表的随机试验。主要结果是任何蚊媒疾病的发生率。次要结果包括疾病传播的昆虫学指标。I2值用于探索研究之间的异质性。采用随机效应荟萃分析评估主要和次要结局，并对家庭环境、研究环境（农村、城市或混合）和整体房屋类型（传统或现代住房）的干预类型进行亚组分析。筛选后，18项研究纳入定性综述，其中9项纳入荟萃分析。这些研究招募了非洲和南美洲的7，200个家庭，仅报告了疟疾或登革热。家庭环境干预措施的类型包括修改天花板和封闭屋檐的丝带，用网遮蔽门窗，在家中使用经杀虫剂处理的墙衬，在山墙和屋檐开口处使用网，捕蚊系统，带有防蚊网的金属屋顶房屋，山墙窗和封闭屋檐，以及使用东南亚设计的原型房屋。合并分析显示，住房干预组的蚊媒疾病风险较低（OR = 0.68; 95%CI = 0.48至0.95; P = 0.03）。亚组分析显示，住房干预降低了所有环境中的疟疾风险（OR = 0.63; 95%CI = 0.39至1.01; P = 0.05）。在城市环境中，发现住房干预可以降低疟疾和登革热感染的风险（OR = 0.52，95%CI = 0.27 ~ 0.99，P = 0.05）.荟萃分析显示，改善居住环境对降低室内媒介伊蚊和按蚊密度有显著作用（OR = 0.35; 95% CI = 0.23 ~ 0.54; P<0.001）。住房干预可以减少疟疾和登革热在居住在家中的人中的传播。今后的研究应评估与城市发展有关的具体住房特征和住房改善的保护作用。
Mosquito-borne diseases remain a significant public health problem in tropical regions. Housing improvements such as screening of doors and windows may be effective in reducing disease transmission, but the impact remains unclear. To examine whether housing interventions were effective in reducing mosquito densities in homes and the impact on the incidence of mosquito-borne diseases. In this systematic review and meta-analysis, we searched 16 online databases, including NIH PubMed, CINAHL Complete, LILACS, Ovid MEDLINE, and Cochrane Central Register of Controlled Trials for randomized trials published from database inception to June 30, 2020. The primary outcome was the incidence of any mosquito-borne diseases. Secondary outcomes encompassed entomological indicators of the disease transmission. I2 values were used to explore heterogeneity between studies. A random-effects meta-analysis was used to assess the primary and secondary outcomes, with sub-group analyses for type of interventions on home environment, study settings (rural, urban, or mixed), and overall house type (traditional or modern housing), The literature search yielded 4,869 articles. After screening, 18 studies were included in the qualitative review, of which nine were included in the meta-analysis. The studies enrolled 7,200 households in Africa and South America, reporting on malaria or dengue only. The type of home environmental interventions included modification to ceilings and ribbons to close eaves, screening doors and windows with nets, insecticide-treated wall linings in homes, nettings over gables and eaves openings, mosquito trapping systems, metal-roofed houses with mosquito screening, gable windows and closed eaves, and prototype houses using southeast Asian designs. Pooled analysis depicted a lower risk of mosquito-borne diseases in the housing intervention group (OR = 0.68; 95% CI = 0.48 to 0.95; P = 0.03). Subgroup analysis depicted housing intervention reduced the risk of malaria in all settings (OR = 0.63; 95% CI = 0.39 to 1.01; P = 0.05). In urban environment, housing intervention was found to decrease the risk of both malaria and dengue infections (OR = 0.52; 95% CI = 0.27 to 0.99; P = 0.05).Meta-analysis of pooled odds ratio showed a significant benefit of improved housing in reducing indoor vector densities of both Aedes and Anopheles (OR = 0.35; 95% CI = 0.23 to 0.54; P<0.001). Housing intervention could reduce transmission of malaria and dengue among people living in the homes. Future research should evaluate the protective effect of specific house features and housing improvements associated with urban development.
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