Interventions against Aedes/dengue at the household level: a systematic review and meta-analysis

Background Because the evidence for the role of structural housing and combinations of interventions (domestic or peri-domestic) against Aedes mosquitoes or dengue is still lacking, this systematic review and meta-analysis aimed to analyse and synthesize research focusing on the household as the unit of allocation. Methods We searched MEDLINE, LILACS, and Web of Science databases until February 2023 using three general keyword categories: (1) Aedes or dengue; (2) structural housing interventions including house, water, or drainage; and (3) vector control interventions of potential relevance and their combinations. We performed a qualitative content analysis and a meta-analysis for 13 entries on dengue seroconversion data. Findings 14,272 articles were screened by titles, 615 by abstracts, 79 by full-text. 61 were selected. Satisfactory data quality allowed for detailed content analysis. Interventions at the household level against the immature mosquito stages (21 studies, 34%) showed positive or mixed results in entomological and epidemiological outcomes (86% and 75% respectively). Combined interventions against immature and adult stages (11 studies, 18%) performed similarly (91% and 67%) while those against the adult mosquitoes (29 studies, 48%) performed less well (79%, 22%). A meta-analysis on seroconversion outcomes showed a not-statistically significant reduction for interventions (log odds-ratio: -0.18 [-0.51, 0.14 95% CI]). Interpretation No basic research on housing structure or modification was eligible for this systematic review but many interventions with clear impact on vector indices and, to a lesser extent, on dengue were described. The small and not-statistically significant effect size of the meta-analysis highlights the difficulty of proving effectiveness against this highly-clustered disease and of overcoming practical implementation obstacles (e.g. efficacy loss, compliance). The long-term success of interventions depends on suitability, community commitment and official support and promotion. The choice of a specific vector control package needs to take all these context-specific aspects into consideration.

Automated summary

This systematic review and meta-analysis examined the effectiveness of structural housing interventions against Aedes mosquitoes and dengue. The results showed that interventions at the household level had positive effects on the immature mosquito stages, but performed less effectively against adult mosquitoes. The meta-analysis did not find a statistically significant reduction in seroconversion outcomes.