Larviciding to prevent malaria transmission

Background Larviciding refers to the regular application of chemical or microbial insecticides to water bodies or water containers to kill the aquatic immature forms of the mosquito (the larvae and pupae). Objectives To summarize research evidence evaluating whether larviciding with chemical or microbial insecticides prevents malaria transmission. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; Embase; CAB Abstracts; LILACS; the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP); ClinicalTrials.gov; and the ISRCTN registry up to 6 June 2019. Selection criteria We included cluster‐randomized controlled trials (cRCTs), interrupted time series (ITS), randomized cross‐over studies, non‐randomized cross‐over studies, and controlled before‐and‐after studies (CBAs) that compared larviciding with no larviciding. Data collection and analysis We independently assessed trials for eligibility and risk of bias, and extracted data. We assessed the certainty of evidence using the GRADE approach. Main results Four studies (one cRCT, two CBAs, and one non‐randomized cross‐over design) met the inclusion criteria. All used ground application of larvicides (people hand‐delivering larvicides); one evaluated chemical and three evaluated microbial agents. Studies were carried out in The Gambia, Tanzania, Kenya, and Sri Lanka. Three studies were conducted in areas where mosquito aquatic habitats were less extensive ( 1 km²; a cross‐over study from The Gambia). For aquatic habitats of less than 1 km², one cRCT randomized eight villages in Sri Lanka to evaluate chemical larviciding using insect growth regulator; and two CBA studies undertaken in Kenya and Tanzania evaluated microbial larvicides. In the cRCT, larviciding across all villages was associated with lower malaria incidence (rate ratio 0.24, 4649 participants, low‐certainty evidence) and parasite prevalence (risk ratio (RR) 0.26, 5897 participants, low‐certainty evidence) compared to no larviciding. The two CBA studies reported lower malaria prevalence during the intervention period (parasite prevalence RR 0.79, 95% confidence interval (CI) 0.71 to 0.89; 70,902 participants; low‐certainty evidence). The Kenyan study also reported a reduction in the incidence of new malaria cases (RR 0.62, 95% CI 0.38 to 1.01; 720 participants; very low‐certainty evidence). For aquatic habitats of more than 1 km², the non‐randomized cross‐over trial using microbial larvicides did not detect an effect for malaria incidence (RR 1.58, 95% CI 0.94 to 2.65; 4226 participants), or parasite prevalence (RR 1.15, 95% CI 0.41 to 3.20; 3547 participants); both were very low‐certainty evidence. The Gambia trial also reported the mean haemoglobin level, and there was no difference across the four comparisons (mean difference –0.13, 95% CI –0.40 to 0.13; 3586 participants). We were unable to summarize or pool entomological outcomes due to unreported and missing data. Authors' conclusions Most controlled studies on larviciding have been performed with microbial agents. Ground larviciding for non‐extensive larval habitats may have an effect on malaria transmission, and we do not know if there is an effect in large‐scale aquatic habitats. We found no studies using larviciding application techniques that could cover large aquatic habitats, such as aerial spraying using aircraft.