Effectiveness and safety of community-based ivermectin interventions for malaria control in Africa: a systematic review and meta-analysis
Domaine:
healthcareType de record:
paper
Créateur:
MuhBonEmmLaw
Éditeur:
Hôte:
Background: Malaria control progress has stalled in many sub-Saharan Africa (SSA) settings despite widespread deployment of existing prevention and treatment strategies. Ivermectin has emerged as a potential transmission-modifying intervention, but evidence of its effectiveness remains uncertain. We conducted a systematic review and meta-analysis to evaluate its effects on malaria epidemiological, entomological, and safety outcomes in African settings.
Methods: We systematically searched PubMed, Ovid Embase, CENTRAL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP), and the Pan African Clinical Trial Registry for eligible African studies evaluating ivermectin alone or combined with antimalarial interventions. Random-effects meta-analysis using Restricted Maximum Likelihood estimation was conducted for outcome-specific pooled analyses. Multilevel meta-analysis, robust variance estimation, and Bayesian sensitivity analyses were additionally performed to account for correlated outcomes and reconstructed variance structures.
Findings: Twelve studies contributed 197 outcome-timepoint estimates, including 175 post-intervention estimates. Malaria incidence or infection outcomes showed modest reduction in malaria burden associated with ivermectin-based interventions (risk ratio, RR 0·93, 95% confidence interval, CI 0·85–1·02), although effects varied across intervention settings and implementation strategies. Entomological outcomes demonstrated the strongest intervention effects, with mosquito mortality substantially reduced following ivermectin exposure (RtR 0·59, 95% CI 0·54–0·64), while entomological inoculation rate outcomes also favoured ivermectin interventions (rate ratio, RtR 0·58, 95% CI 0·35–0·96). Mosquito survival outcomes similarly demonstrated reduced vector survival potential (RtR 0·77, 95% CI 0·58–1·01). Serious adverse events or deaths were not clearly increased (RR 1·05, 95% CI 0·74–1·48), but any adverse events were more frequently reported among ivermectin recipients (RR 1.47, 95% CI 1.04–2.10).
Interpretation: Community-based ivermectin interventions consistently reduced entomological transmission indicators, although evidence for direct epidemiological benefit remained modest and context-dependent. These findings support ivermectin as a complementary transmission-modifying intervention rather than a standalone malaria elimination strategy.
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