Dual-active-ingredient, insecticidal nets for preventing malaria: a systematic review protocol

Background: Malaria is caused by the Plasmodium parasite and is a highly transmissible disease representing a significant global public health burden. The provision of insecticide-treated mosquito nets (ITNs) has contributed to the reduction of malaria across endemic countries. However, the detection of insecticide resistance in many mosquito vector species potentially threatens the long-term effectiveness of ITNs. A novel method to reduce the impact of insecticide resistance is to treat mosquito nets with multiple active ingredients. Methods and analysis: This review will comprehensively search the literature (both published and unpublished) for any studies investigating the effectiveness of mosquito nets treated with multiple active ingredients, known henceforth as dual-active-ingredient (DAI) ITNs. The DAI ITNs of interest include those treated with a pyrethroid and non-pyrethroid insecticide (review question 1) or with a pyrethroid and an insect growth regulator (review question 2). Studies will be screened to meet the inclusion criteria by a minimum of two authors, followed by assessment of risk of bias (using appropriate risk of bias tools for randomised and non-randomised studies) and extraction of relevant information using structured forms by two independent authors. Meta-analyses will be carried out where possible for epidemiological outcomes and subgrouping will be considered. Certainty in the evidence will be established with GRADE assessments. Ethics and dissemination: A full review report will be submitted to the Vector Control and Insecticide Resistance Unit, Global Malaria Program, WHO. A version of this report will be submitted for publication in an open access peer-reviewed journal. The report will inform the development of WHO recommendations regarding the use of DAI ITNs for the prevention of malaria. This systematic review does not require ethics approval as it is a review of primary studies.Timothy Barker, Jennifer Stone, Sabira Hasanoff, Jennifer Stevenson, Carrie Price, Alinune Kabaghe, Zachary Mun