Mosquito repellents for malaria prevention



Marta F Maia1,2,*,Merav Kliner3, Marty Richardson4, Christian Lengeler1,  Sarah J Moore1

1. Swiss Tropical and Public Health Institute, Public Health and Epidemiology, Basel, Switzerland 
2. Kenya Medical Research Insitute - Wellcome Trust Programme, Department of Biosciences, Kilifi, Kenya
3. Public Health England North West, Health Protection Team, Manchester, UK

4. Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK

Maia MF, Kliner M, Richardson M, Lengeler C, Moore SJ. Mosquito repellents for malaria prevention. Cochrane Database of Systematic Reviews 2018, Issue 2. Art. No.: CD011595. DOI: 10.1002/14651858.CD011595.pub2

Access the full-text here: DOI: 10.1002/14651858.CD011595.pub2/full

What was the aim of this review?

The aim of this Cochrane Review was to find out if mosquito repellents — topical repellents (applied to the skin); insecticide-treated clothing; or spatial repellents such as mosquito coils — can prevent malaria. We collected and analysed the results of all relevant studies to answer this question and found data from ten trials: six on topical repellents, two on insecticide-treated clothing, and two on spatial repellents.

Key messages

We do not know if the use of repellent lotions or burning of mosquito coils can provide protection from malaria to communities living in endemic regions. In situations where long-lasting insecticide-treated bed nets (LLINs) cannot be rolled out, such as after a natural disaster or amongst displaced populations, the use of insecticide-treated clothing may reduce the risk of malaria infection by 50%. Most studies included in our analysis were poorly designed and had high risk of bias. In order to draw well-informed conclusions, further high-quality studies must be conducted to improve the certainty of the evidence. However, it is questionable if topical repellents can be used for malaria prevention in the general population as daily compliance and poor standardization (amount of repellent used, surface area applied, time of application, and period between repeated applications) are major limitations of this intervention.

What was studied in this review

Mosquito repellents provide protection from mosquito bites. There are three different types of repellents: topical repellents, which can be applied on the skin; insecticide-treated clothing, through impregnation of clothing with repellent compounds; and spatial repellents, such as mosquito coils. Malaria has decreased in many countries because people have been given highly effective LLINs. However people are still being bitten before they go to bed. There is a need to find a way to offer protection from malaria during these hours. Mosquito repellents may address this gap.

What are the main results of the review?

A total of six trials investigated the use of topical repellents for malaria prevention. The trials took place in different malaria-endemic regions across South America, Asia, and sub-Saharan Africa. The topical repellents tested included lotions, treated soap, and local cosmetics. We analysed the studies in groups according to LLIN inclusion. Most studies rolled out LLINs to the population and investigated topical repellents as a complementary intervention to the treated bed-nets. The poor design of the included studies provided low to very low certainty evidence, consequently we do not know if there is a benefit of using topical repellents in addition to LLINs to prevent malaria. The compliance of participants to adhere to the daily application of repellents remains a challenge to further research.

Insecticide-treated clothing was investigated in two trials conducted with refugees in Pakistan and military deployed in the Amazon; neither study rolled out or reported the use of bed-nets. In the absence of LLINs, there is some evidence that insecticide-treated clothing may reduce the risk of malaria infection by 50%. Given that the findings relate to special populations living in particularly harsh conditions it is unclear if the results are applicable to the general population. Further studies involving civilian populations should be done to improve the certainty of these findings.

Two studies investigated the practice of burning mosquito coils to reduce malaria infections. One study was conducted in China and the other in Indonesia. The study designs were substantially different and one study had high risk of bias leading to very low certainty evidence. We do not know if mosquito coils offer protection against malaria. The findings underline the need for further research.