【Cochrane简语概要】对未成熟蚊子的水环境进行哪些永久性和临时性改变可以更好地减少人类的疟疾？

为什么减少人类的疟疾很重要？

疟疾对民众的健康影响非常大，主要是非洲和亚洲的人们。多年来，人们一直在研究减少疟疾的策略。大多数策略侧重于减少未成熟蚊子（幼虫和蛹）的数量，以防止它们变成成年蚊子，因为成年雌性蚊子可以通过叮咬人传播疟疾。

（图片来自University of Leeds）

对未成熟蚊子的环境的永久和临时变化是什么？

可以使用永久（改造）和临时（干预）改变来扰乱未成熟蚊子生活的水环境。永久性改变的例子包括修建排水渠、平整土地和填充沟渠。临时改变的例子包括改变溪流的水流、排水渠、割草、使用植物遮蔽水面。这些干预措施可以单独使用，也可以与其他标准处理措施一起使用，例如定期向水体喷洒杀虫剂（杀幼虫剂）。

我们想从中发现什么？

我们想找出对未成熟蚊子环境的哪些永久性和临时性改变可以减少人类的疟疾（临床结局），以及未成熟和成年蚊子的数量（昆虫学结局）。

我们做了什么？

我们检索了关于与无干预或不同的永久或临时变化相比，对未成熟蚊子环境进行永久和临时改变的研究。我们比较并总结了研究结果，还根据诸如研究方法等因素来评定证据的可信度。

我们发现了什么?

综述包括16项研究，这些研究使用了一系列不同的随机和非随机研究设计。11项研究在非洲进行，5项在亚洲进行。只有少数研究报告了临床结局，其中大部分关注未成熟蚊子或成年蚊子或两者的数量（昆虫学结局）。我们发现有一些证据支持对水环境进行永久（改造）和临时（干预）改变，以减少特定环境中未成熟蚊子的数量。然而，在观察临床结局时，1. 栖息地改造对疟疾寄生虫流行率和临床疟疾发病率的影响尚不清楚；2. 使用环境改造和杀幼虫剂可能会降低疟疾寄生虫的流行；3. 将改造和干预与杀幼虫结合起来可能对疟疾寄生虫流行率和血红蛋白水平影响很小或没有影响。

证据的局限性是什么？

综述包括对未成熟蚊子的水环境进行各种不同的改变，其中一些将它们与水处理（杀幼虫）相结合，这意味着很少有研究关注相同的干预措施。许多纳入的研究都存在关于它们执行情况的问题。

证据的时效性如何？

本综述更新了2013年Cochrane综述。证据更新截至2021年11月30日。

作者结论: 

从流行病学和昆虫学结局方面， 栖息地改造和干预对预防疟疾有一定的益处。虽然数据非常不一致，进一步的研究可以帮助完善知识库，但这些不同的方法在某些情况下可能会有用。

作者：Martello E, Yogeswaran G, Reithinger R, Leonardi-Bee J；译者：陈永凤,Cochrane Hong Kong，香港中文大学医学院那打素护理学院; 审校：牟焕玉, Cochrane Hong Kong，香港中文大学医学院那打素护理学院；编辑排版：索于思，北京中医药大学循证医学中心

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【Cochrane Plain Language Summary】

Which permanent and temporary changes to the water environments of immature mosquitoes work better to reduce malaria in people?

Why is it important to reduce malaria in people?

Malaria has a very high impact on the health of the public, mostly in people in Africa and Asia. Strategies to reduce malaria have been studied for many years. Most strategies focus on reducing the number of immature mosquitoes (larvae and pupae) to prevent them from becoming adult mosquitoes, since it is the adult female mosquito that can spread malaria through biting people.

What are permanent and temporary changes to the environment of immature mosquitoes?

The water environments where immature mosquitoes live can be disturbed using permanent (modification) and temporary (manipulation) changes. Examples of permanent changes include construction of drainage canals, land levelling, and filling ditches. Examples of temporary changes include altering the flow of water in streams, draining canals, cutting grass, shading of water using plants. These interventions may be used on their own or together with other standard treatments, such as the regular application of insecticides to water bodies (larviciding).

What did we want to find out?

We wanted to find out which permanent and temporary changes to the environment of immature mosquitoes reduce malaria in people (clinical outcomes), and the quantity of immature and adult mosquitoes (entomological outcomes).

What did we do?

We searched for studies that looked at permanent and temporary changes to the environment of immature mosquitoes compared to no intervention or a different permanent or temporary change. We compared and summarized the results of the studies and rated our confidence in the evidence, based on factors such as study methods.

What did we find?

The review included 16 studies that used a range of different randomized and non-randomized study designs. Eleven studies were conducted in Africa and five in Asia. Only a few studies reported clinical outcomes, with most focussing on the number of immature mosquitoes, or adult mosquitoes, or both (entomological outcomes). We found there was some evidence to support the use of permanent (modification) and temporary (manipulation) changes to the water environments to reduce the number of immature mosquitoes in specific settings. However, when looking at clinical outcomes, 1. the effect of habitat manipulation on malaria parasite prevalence and clinical malaria incidence was unclear; 2. malaria parasite prevalence may be reduced when using habitat manipulation with larviciding; 3. combining manipulation and modification with larviciding probably makes little or no difference to malaria parasite prevalence and haemoglobin levels.

What are the limitations of the evidence?

The review included a wide range of different changes to the water environment of immature mosquitoes, with some combining them with water treatments (larviciding), which meant that very few studies looked at the same intervention. Many of the included studies had issues regarding how well they were conducted.

How up to date is the evidence?

This review updates a 2013 Cochrane Review. The evidence is up to date to 30 November 2021.

Authors' conclusions: 

Habitat modification and manipulation interventions for preventing malaria has some indication of benefit in both epidemiological and entomological outcomes. While the data are quite mixed and further studies could help improve the knowledge base, these varied approaches may be useful in some circumstances.

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