Piperonyl butoxide (PBO) combined with pyrethroids in insecticide‐treated nets to prevent malaria in Africa

Background: Public health strategies that target mosquito vectors, particularly pyrethroid long-lasting insecticidal nets (LLINs), have been largely responsible for the substantial reduction in the number of people in Africa developing malaria. The spread of insecticide resistance in Anopheles mosquitoes threatens these impacts. One way to control insecticide-resistant populations is by using insecticide synergists. Piperonyl butoxide (PBO) is a synergist that inhibits specific metabolic enzymes within mosquitoes and has been incorporated into pyrethroid-LLINs to form pyrethroid-PBO nets. Pyrethroid-PBO nets are currently produced by four LLIN manufacturers and,following a recommendation from the World Health Organization (WHO) in 2017, are being included in distribution campaigns incountries. This review examines epidemiological and entomological evidence on whether the addition of PBO to LLINs improves theirefficacy.

Objectives1. Evaluate whether adding PBO to pyrethroid LLINs increasesthe epidemiological and entomological effectiveness of the nets.2. Compare the effects of pyrethroid-PBO nets currently in commercial development or on the market with their non-PBO equivalentin relation to:a. malaria infection (prevalence or incidence);b. entomological outcomes.

Search methods . We searched the Cochrane Infectious Diseases Group (CIDG) Specialized Register; CENTRAL, MEDLINE, Embase, Web of Science,CAB Abstracts, and two clinical trial registers (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) up to 24August 2018. We contacted organizations for unpublished data. We checked the reference lists of trials identified by the above methods.