The quality of evidence is downgraded by study limitations (improper methodologies for random sequence generation and allocation concealment) and by imprecision (underpowered studies, wide confidence intervals). Regarding the spatial repellents, the quality of evidence is downgraded also by inconsistency (unexplained variability in results).
A Cochrane review [Abstract] 1 included 10 studies. Six studies (n=67 297, residents of malaria-endemic regions) investigated the impact of topical repellent compared to placebo or no treatment, 2 studies (n=997, refugee camp and military setting) the impact of insecticide-treated clothing (ITC) compared to placebo or no treatment, and two studies (2497 households, residents of malaria-endemic regions) the impact of spatial repellents (mosquito coils) compared to placebo or no treatment. According to the results, it was not clear whether the use of topical repellents brings additional benefit over that achieved by using long-lasting insecticide-treated bed nets (LLINs) to prevent malaria. In the absence of nets, ITC reduced the incidence of clinical malaria caused by P. falciparum by approximately 50% (RR 0.49, 95% CI 0.29 to 0.83, low-certainty evidence) and P. vivax (RR 0.64, 95% CI 0.40 to 1.01, low-certainty evidence). Included studies regarding spatial repellents only considered mosquito coils and the results were inconclusive.
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