Piperonyl butoxide (PBO) combined with pyrethroids in insecticide‐treated nets to prevent malaria in Africa

Katherine Gleave<sup>a</sup>; Natalie Lissenden<sup>a</sup>; Marty Chaplin; Leslie Choi; Hilary Ranson

doi:10.1002/14651858.CD012776.pub3

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Figure 1

Study flow diagram.

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Figure 2

‘Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1: Commercial pyrethroid‐PBO nets versus commercial LLINs: village trials, Outcome 1: Parasite prevalence (pyrethroid‐PBO nets vs non‐PBO LLINs, latest end points in RCT)

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Analysis 1.2

Comparison 1: Commercial pyrethroid‐PBO nets versus commercial LLINs: village trials, Outcome 2: Parasite prevalence (pyrethroid‐PBO nets vs non‐PBO LLINs, shown at 4 different time points)

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Analysis 1.3

Comparison 1: Commercial pyrethroid‐PBO nets versus commercial LLINs: village trials, Outcome 3: Mosquito sporozoite‐positive (adjusted ICC 0.1)

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Analysis 1.4

Comparison 1: Commercial pyrethroid‐PBO nets versus commercial LLINs: village trials, Outcome 4: Mosquito parous (adjusted ICC 0.1)

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Analysis 2.1

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 1: Mosquito mortality (pooled) hut/night (adjusted ICC 0.1)

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Analysis 2.2

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 2: Mosquito blood‐feeding success (pooled) hut/night (adjusted ICC 0.1)

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Analysis 2.3

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 3: Mosquito exophily (pooled) hut/night (adjusted ICC 0.1)

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Analysis 2.4

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 4: Mosquito mortality (high resistance) hut/night (adjusted ICC 0.1)

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Analysis 2.5

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 5: Mosquito blood‐feeding success (high resistance) hut/night (adjusted ICC 0.1)

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Analysis 2.6

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 6: Mosquito mortality (moderate resistance) hut/night (adjusted ICC 0.1)

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Analysis 2.7

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 7: Mosquito blood‐feeding success (moderate resistance) hut/night (adjusted ICC 0.1)

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Analysis 2.8

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 8: Mosquito mortality (low resistance) hut/night (adjusted ICC 0.1)

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Analysis 2.9

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 9: Mosquito blood‐feeding success (low resistance) hut/night (adjusted ICC 0.1)

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Analysis 2.10

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 10: Mosquito mortality (susceptible) hut/night (adjusted ICC 0.1)

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Analysis 2.11

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 11: Mosquito blood‐feeding success (susceptible) hut/night (adjusted ICC 0.1)

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Analysis 2.12

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 12: Mosquito mortality (high resistance/Permanet) hut/night (adjusted ICC 0.1)

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Analysis 2.13

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 13: Mosquito blood‐feeding success (high resistance/Permanet) hut/night (adjusted ICC 0.1)

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Analysis 2.14

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 14: Mosquito mortality (high resistance/Olyset) hut/night (adjusted ICC 0.1)

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Analysis 2.15

Comparison 2: Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials, Outcome 15: Mosquito blood‐feeding success (high resistance/Olyset) hut/night (adjusted ICC 0.1)

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Summary of findings 1. Summary of findings table 1

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	Number of participants, (trials)	Certainty of the evidence (GRADE)	Comments
Pyrethroid‐piperonyl butoxide (PBO) nets compared to long‐lasting insecticidal nets (LLINs) for malaria control when insecticide resistance is high
Patient or population: adults and childen living in malaria‐endemic areas, Anopheles gambiae complex or Anopheles funestus group Setting: areas of high insecticide resistance Intervention: pyrethroid‐PBO nets Comparison: LLIN
Outcomes	Risk with LLIN	Risk with pyrethroid‐PBO nets	Relative effect (95% CI)	Number of participants, (trials)	Certainty of the evidence (GRADE)	Comments
Parasite prevalence (4‐ to 6‐month follow‐up)	254 per 1000^a	201 per 1000 (174 to 233)^a	OR 0.74 (0.62 to 0.89)	11,582 people (2 trials, 2 comparisons, 61 PBO clusters, 64 non‐PBO clusters)	⊕⊕⊕⊕ HIGH	Pyrethroid‐PBO nets at 4‐ to 6‐month follow‐up reduce parasite prevalence in areas of high insecticide resistance
Parasite prevalence (9‐ to 12‐month follow‐up)	224 per 1000^a	172 per 1000 (150 to 199)^a	OR 0.72 (0.61 to 0.86)	11,370 people (2 trials, 2 comparisons, 61 PBO clusters, 64 non‐PBO clusters)	⊕⊕⊕⊝ MODERATE^b due to inconsistency	Pyrethroid‐PBO nets at 9‐ to 12‐month follow‐up reduce parasite prevalence in areas of high insecticide resistance
Parasite prevalence (16‐ to 18‐month follow‐up)	248 per 1000^a	225 per 1000 (196 to 255)^a	OR 0.88 (0.74 to 1.04)	11,822 people (2 trials, 2 comparisons, 61 PBO clusters, 64 non‐PBO clusters)	⊕⊕⊕⊝ MODERATE^b due to inconsistency	Pyrethroid‐PBO nets at 16‐ to 18‐month follow‐up reduce parasite prevalence in areas of high insecticide resistance
Parasite prevalence (21‐ to 25‐month follow‐up)	350 per 1000^a	298 per 1000 (265 to 338)^a	OR 0.79 (0.67 to 0.95)	10,603 people (2 trials, 2 comparisons, 54 PBO clusters, 60 non‐PBO clusters)	⊕⊕⊕⊝ MODERATE^b due to inconsistency	Pyrethroid‐PBO nets at 21‐ to 25‐month follow‐up reduce parasite prevalence in areas of high insecticide resistance
Mosquito mortality (unwashed nets)	238 per 1000^a	438 per 1000 (381 to 503)^a	RR 1.84 (1.60 to 2.11)	14,620 mosquitoes (5 trials, 9 comparisons)	⊕⊕⊕⊕ HIGH^c	Mosquito mortality is higher with unwashed pyrethroid‐PBO nets compared to standard unwashed LLINs in areas of high insecticide resistance
Mosquito mortality (washed nets)	201 per 1000^a	242 per 1000 (177 to 328)^a	RR 1.20 (0.88 to 1.63)	10,268 mosquitoes (4 trials, 5 comparisons)	⊕⊝⊝⊝ VERY LOW^d,e due to imprecision and inconsistency	We do not know whether pyrethroid‐PBO nets have an effect on mosquito mortality in areas of high insecticide resistance when the nets have been washed
Blood‐feeding success (unwashed nets)	438 per 1000^a	263 per 1000 (241 to 311)^a	RR 0.60 (0.50 to 0.71)	14,000 mosquitoes (4 trials, 8 comparisons)	⊕⊕⊕⊕ HIGH^c	Mosquito blood‐feeding success is decreased with unwashed pyrethroid‐PBO nets compared to standard unwashed LLINs in areas of high insecticide resistance
Blood‐feeding success (washed nets)	494 per 1000^a	400 per 1000 (356 to 454)^a	RR 0.81 (0.72 to 0.92)	9674 mosquitoes (3 trials, 4 comparisons)	⊕⊕⊕⊕ HIGH^c	Mosquito blood‐feeding success is decreased with washed pyrethroid‐PBO nets compared to standard washed LLINs in areas of high insecticide resistance
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; LLINs: long‐lasting insecticidal nets; OR: odds ratio; PBO: pyrethroid‐piperonyl butoxide; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^aOriginal numbers were used in this table; however in pooled analysis, events and total numbers were generated from cluster‐adjusted results, which use the effective sample size. Note that cluster adjustments do not change the point estimate of the effect size ‐ just the standard error. ^bDowngraded by one for inconsistency. ^cNot downgraded for imprecision: both best‐ and worst‐case scenarios in this situation are important effects. ^dDowngraded by one for imprecision due to wide CIs. ^eDowngraded by two for inconsistency due to unexplained qualitative heterogeneity.

Summary of findings 1. Summary of findings table 1

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Summary of findings 2. Summary of findings table 2

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	Number of mosquitoes (experimental hut trials)	Certainty of the evidence (GRADE)	Comments
Pyrethroid‐piperonyl butoxide (PBO) nets compared to long‐lasting insecticidal nets (LLINs) for malaria control when insecticide resistance is moderate
Patient or population:Anopheles gambiae complex or Anopheles funestus group Setting: areas of moderate insecticide resistance Intervention: pyrethroid‐PBO nets Comparison: LLIN
Outcomes	Risk with LLIN	Risk with pyrethroid‐PBO nets	Relative effect (95% CI)	Number of mosquitoes (experimental hut trials)	Certainty of the evidence (GRADE)	Comments
Mosquito mortality (unwashed nets)	180 per 1000^a	303 per 1000 (259 to 411)^a	RR 1.68 (1.33 to 2.11)	1007 (2 trials, 3 comparisons)	⊕⊕⊕⊝ MODERATE^b due to imprecision	Mosquito mortality is probably higher with unwashed pyrethroid‐PBO nets compared to standard unwashed LLINs in areas of moderate insecticide resistance
Mosquito mortality (washed nets)	287 per 1000^a	307 per 1000 (213 to 443)^a	RR 1.07 (0.74 to 1.54)	329 (1 trial, 1 comparison)	⊕⊕⊝⊝ LOW^b,c,d due to imprecision and indirectness	There may be little to no difference in the effect of washed pyrethroid‐PBO nets on mosquito mortality compared to standard washed LLINs (washed) in areas of moderate insecticide resistance
Blood‐feeding success (unwashed nets)	258 per 1000^a	232 per 1000 (197 to 304)^a	RR 0.90 (0.72 to 1.11)	1006 (2 trials, 3 comparisons)	⊕⊕⊕⊝ MODERATE^b due to imprecision	There is probably little to no difference in the effect of pyrethroid‐PBO nets (unwashed) on mosquito blood‐feeding success compared to standard LLINs in areas of moderate insecticide resistance
Blood‐feeding success (washed nets)	586 per 1000^a	533 per 1000 (434 to 662)^a	RR 0.91 (0.74 to 1.13)	329 (1 trial, 1 comparison)	⊕⊕⊝⊝ LOW^b,c,d due to imprecision and indirectness	There may be little to no difference in the effect of washed pyrethroid‐PBO nets on mosquito blood‐feeding success compared to standard washed LLINs in areas of moderate insecticide resistance
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; LLIN: long‐lasting insecticidal net; PBO: pyrethroid‐piperonyl butoxide; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^aOriginal numbers are used in this table; however for the pooled analysis, we generated events and total numbers from cluster‐adjusted results, which used the effective sample size. Note that cluster adjustments do not change the point estimate of the effect size, just the standard error. ^bDowngraded by one for imprecision due to wide CIs. ^cNot downgraded for inconsistency, as only one trial measured this outcome in this setting. ^dDowngraded by one for indirectness: the outcome is highly context‐specific, and only one trial is included.

Summary of findings 2. Summary of findings table 2

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Summary of findings 3. Summary of findings table 3

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	Number of mosquitoes (experimental hut trials)	Certainty of the evidence (GRADE)	Comments
Pyrethroid‐piperonyl butoxide (PBO) nets compared to long‐lasting insecticidal nets (LLINs) for malaria control when insecticide resistance is low
Patient or population:Anopheles gambiae complex or Anopheles funestus group Setting: areas of low insecticide resistance Intervention: pyrethroid‐PBO nets Comparison: LLINs
Outcomes	Risk with LLINs	Risk with pyrethroid‐PBO nets	Relative effect (95% CI)	Number of mosquitoes (experimental hut trials)	Certainty of the evidence (GRADE)	Comments
Mosquito mortality (unwashed nets)	527 per 1000^a	659 per 1000 (613 to 972)^a	RR 1.25 (0.99 to 1.57)	1580 (2 trials, 3 comparisons)	⊕⊕⊕⊝ MODERATE^b due to imprecision	There is probably little to no difference in the effect of unwashed pyrethroid‐PBO nets on mosquito mortality compared to standard unwashed LLINs in areas of low insecticide resistance
Mosquito mortality (washed nets)	394 per 1000^a	547 per 1000 (437 to 938)^a	RR 1.39 (0.95 to 2.04)	1774 (2 trials, 3 comparisons)	⊕⊝⊝⊝ VERY LOW^c,d due to imprecision and inconsistency	We do not know if pyrethroid‐PBO nets have an effect on mosquito mortality in areas of low insecticide resistance when the nets have been washed
Blood‐feeding success (unwashed nets)	201 per 1000^a	151 per 1000 (58 to 456)^a	RR 0.75 (0.27 to 2.11)	1580 (2 trials, 3 comparisons)	⊕⊝⊝⊝ VERY LOW^c,d due to imprecision and inconsistency	We do not know if unwashed pyrethroid‐PBO nets have an effect on mosquito blood‐feeding success in areas of low insecticide resistance
Blood‐feeding success (washed nets)	161 per 1000^a	172 per 1000 (122 to 578)^a	RR 1.07 (0.49 to 2.33)	1774 (2 trials, 3 comparisons)	⊕⊕⊝⊝ LOW^d due to inconsistency	Mosquito blood‐feeding success may decrease with washed pyrethroid‐PBO nets compared to standard washed LLINs in areas of low insecticide resistance
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; LLIN: long‐lasting insecticidal net; PBO: pyrethroid‐piperonyl butoxide; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^aOriginal numbers are used in this table; however for the pooled analysis, events and total numbers were generated from cluster‐adjusted results, which use the effective sample size. Note that cluster adjustments do not change the point estimate of the effect size, just the standard error. ^bDowngraded by one for imprecision due to wide CIs. ^cDowngraded by one for inconsistency due to unexplained heterogeneity. ^dDowngraded by two for imprecision due to extremely wide CIs.

Summary of findings 3. Summary of findings table 3

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Summary of findings 4. Summary of findings table 4

Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	Number of mosquitoes (experimental hut trials)	Certainty of the evidence (GRADE)	Comments
Pyrethroid‐piperonyl butoxide (PBO) nets compared to long‐lasting insecticidal nets (LLINs) for malaria control when mosquitoes are susceptible
Patient or population:Anopheles gambiae complex or Anopheles funestus group Setting: areas of insecticide‐susceptible mosquitoes Intervention: pyrethroid‐PBO nets Comparison: LLINs
Outcomes	Risk with LLINs	Risk with pyrethroid‐PBO nets	Relative effect (95% CI)	Number of mosquitoes (experimental hut trials)	Certainty of the evidence (GRADE)	Comments
Mosquito mortality (unwashed nets)	392 per 1000^a	471 per 1000 (251 to 887)^a	RR 1.20 (0.64 to 2.26)	2791 (2 trials, 2 comparisons)	⊕⊕⊝⊝ LOW^b due to imprecision	There may be little to no difference in the effect of unwashed pyrethroid‐PBO nets on mosquito mortality compared to standard unwashed LLINs in areas of no insecticide resistance
Mosquito mortality (washed nets)	457 per 1000^a	489 per 1000 (420 to 571)^a	RR 1.07 (0.92 to 1.25)	2644 (2 trials, 2 comparisons)	⊕⊕⊝⊝ LOW^b due to imprecision	There may be little to no difference in the effect of washed pyrethroid‐PBO nets on mosquito mortality compared to standard washed LLINs in areas of no insecticide resistance
Blood‐feeding success (unwashed nets)	57 per 1000^a	29 per 1000 (6 to 132)^a	RR 0.52 (0.12 to 2.22)	2791 (2 trials, 2 comparisons)	⊕⊝⊝⊝ VERY LOW^b,c due to imprecision and inconsistency	We do not know if unwashed pyrethroid‐PBO nets have an effect on mosquito blood‐feeding success in areas of no insecticide resistance
Blood‐feeding success (washed nets)	64 per 1000^a	82 per 1000 (52 to 131)^a	RR 1.25 (0.82 to 1.91)	2644 (2 trials, 2 comparisons)	⊕⊝⊝⊝ VERY LOW^b,c due to imprecision and inconsistency	We do not know if washed pyrethroid‐PBO nets have an effect on mosquito blood‐feeding success in areas of no insecticide resistance
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; LLINs: long‐lasting insecticidal nets; PBO: pyrethroid‐piperonyl butoxide; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^aOriginal numbers are used in this table; however for the pooled analysis, events and total numbers were generated from cluster‐adjusted results, which use the effective sample size. Note that cluster adjustments do not change the point estimate of the effect size, just the standard error. ^bDowngraded by two for imprecision due to extremely wide CIs. ^cDowngraded by one for inconsistency due to unexplained heterogeneity.

Summary of findings 4. Summary of findings table 4

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Table 1. World Health Organization Pesticide Evaluation Scheme (WHOPES) classification

WHOPES Phase	Definition
WHOPES Phase I. Laboratory bioassays	Cone bioassays: these studies are conducted in the laboratory setting and use standard WHO protocols (WHO 2013, Section 2.2.1), when mosquitoes are exposed to a suitable LLIN (treated intervention or untreated control) for three minutes using a standard plastic WHO cone. Following net exposure, mosquitoes are transferred to a holding container and are maintained on a sugar solution diet while entomological outcomes (mosquitoes knocked down 1 hour post exposure, and mosquito mortality 24 hours post exposure) are measured. Tunnel tests: these studies are conducted in the laboratory setting and use standard WHO protocols (WHO 2013, Section 2.2.2). Mosquitoes are released into a glass tunnel covered at each end with untreated netting. The intervention or control LLIN net sample is placed one‐third down the length of the tunnel, and the net contains 9 holes that enable mosquitoes to pass through. A suitable bait is immobilized in the shorter section of the tunnel, where it is available for mosquito biting. Mosquitoes are released into the opposite end of the tunnel and must make contact with the net and locate holes before they are able to feed on the bait. After 12 to 15 hours, mosquitoes are removed from both sections of the tunnel, and entomological outcomes (the number of mosquitoes in each section, mortality, and blood‐feeding inhibition at the end of the assay and 24 hours post exposure) are recorded. Wire‐ball bioassays: these studies are conducted in the laboratory setting, where mosquitoes are introduced into a wire‐ball frame that has been covered with the intervention or control LLIN. Mosquitoes are exposed for 3 minutes, after which they are transferred to a holding container, and entomological outcomes (mosquitoes knocked down 1 hour post exposure, and mosquito mortality 24 hours post exposure) are measured.
WHOPES Phase II. Experimental hut trials	WHOPES Phase II experimental hut trials are field trials conducted in Africa where wild mosquito populations or local colonized populations are evaluated. Volunteers or livestock sleep in experimental huts under a purposefully holed LLIN, with 1 person or animal per hut. Huts are designed to resemble local housing based on a West or East African design (WHO 2013; Section 3.3.1‐2). However these trials have identical design features, such as eave gaps or entry slits to allow mosquitoes to enter, and exit traps to capture exiting mosquitoes. LLINs and volunteers are randomly allocated to huts and are rotated in a Latin square to avoid bias, with huts cleaned between rotations to avoid contamination. Several nets, including an untreated control net, can be tested at the same time. Dead and live mosquitoes are collected each morning from inside the net, inside the hut, and inside the exit traps. They are then scored as blood‐fed or non‐blood‐fed, and as alive or dead, and live mosquitoes are maintained for a further 24 hours to assess delayed mosquito mortality.
WHOPES Phase III. Village trials	WHOPES Phase III village trials are conducted in Africa where wild mosquito populations are evaluated. Villages chosen to be included in the study are similar in terms of size, housing structure, location, and data available on insecticide resistance status of local malaria vectors. Households are assigned as conventional LLINs or PBO‐LLINs. Randomization can be done at the household or village level. Adult mosquitoes are collected from study houses, and mosquito density is measured. An indication of malaria transmission is measured at the study sites by recording infections in mosquitoes, parasite prevalence, or malaria incidence.
LLIN: long‐lasting insecticidal nets; PBO: piperonyl butoxide; WHOPES: World Health Organization Pesticide Evaluation Scheme.

Table 1. World Health Organization Pesticide Evaluation Scheme (WHOPES) classification

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Table 2. World Health Organization (WHO)‐recommended long‐lasting insecticidal nets (LLINs)

Product name	Product type	Status of WHO recommendation
DawaPlus 2.0	Deltamethrin coated on polyester	Interim
DawaPlus 3.0	Combination of deltamethrin coated onto polyester (side panels) and deltamethrin and PBO incorporated into polyester (roof)	Interim
DawaPlus 4.0	Deltamethrin and PBO incorporated into polyester	Interim
Duranet	Alpha‐cypermethrin incorporated into polyethylene	Full
Interceptor	Alpha‐cypermethrin coated on polyester	Full
Interceptor G2	Alpha‐cypermethrin and chlorfenapyr incorporated into polyester	Interim
LifeNet	Deltamethrin incorporated into polypropylene	Interim
MAGNet	Alpha‐cypermethrin incorporated into polyethylene	Full
MiraNet	Alpha‐cypermethrin incorporated into polyethylene	Interim
Olyset Net	Permethrin incorporated into polyethylene	Full
Olyset Plus	Permethrin (20 g/kg) and PBO (10 g/kg) incorporated into polyethylene	Interim
Panda Net 2.0	Deltamethrin incorporated into polyethylene	Interim
PermaNet 2.0	Deltamethrin coated on polyester	Full
PermaNet 3.0	Combination of deltamethrin coated on polyester with strengthened border (side panels) and deltamethrin and PBO incorporated into polyethylene (roof)	Interim
Royal Sentry	Alpha‐cypermethrin incorporated into polyethylene	Full
SafeNet	Alpha‐cypermethrin coated on polyester	Full
Veeralin	Alpha‐cypermethrin and PBO incorporated into polyethylene	Interim
Yahe	Deltamethrin coated on polyester	Interim
Yorkool	Deltamethrin coated on polyester	Full
LLIN: long‐lasting insecticidal net; PBO: piperonyl butoxide; WHO: World Health Organization.

Table 2. World Health Organization (WHO)‐recommended long‐lasting insecticidal nets (LLINs)

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Table 3. World Health Organization (WHO)‐recommended insecticide products for treatment of mosquito nets for malaria vector control

Insecticide	Formulation	Dosage^a
Alpha‐cypermethrin	SC 10%	20 to 40
Cyfluthrin	EW 5%	50
Deltamethrin	SC 1% WT 25% WT 25% + binder^b	15 to 25
Etofenprox	EW 10%	200
Lambda‐cyhalothrin	CS 2.5%	10 to 15
Permethrin	EC 10%	200 to 500
EC: emulsifiable concentrate; EW: emulsion, oil in water; CS: capsule suspension; SC: suspension concentrate; WT: water dispersible tablet. ^aActive ingredient/netting (mg/m²). ^bK‐O TAB 1‐2‐3.

Table 3. World Health Organization (WHO)‐recommended insecticide products for treatment of mosquito nets for malaria vector control

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Table 4. Definition of resistance level

Outcome	Confirmed resistance	Suspected resistance	Susceptible	Unclassified
WHO mosquito mortality^a	< 90%	90% to 97%	98% to 100%	Unknown
CDC knock‐down^b	< 90%	80% to 97%	98% to 100%	Unknown
CDC: Centers for Disease Control and Prevention; WHO: World Health Organization. ^aDefinition of resistance level based on mosquito mortality (%) after exposure to insecticide in a WHO diagnostic dose assay. ^bDefinition of resistance level based on mosquito mortality (%) after exposure to insecticide in a CDC bottle bioassay using the methods, diagnostic doses, and diagnostic times recommended by each test respectively.

Table 4. Definition of resistance level

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Table 5. Stratification of resistance level

Outcome	Low	Moderate	High	Unclassified
Mosquito mortality^a	61% to 90%	31% to 60%	< 30%	Unknown
^a24‐hour post‐exposure mortality (%).

Table 5. Stratification of resistance level

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Table 6. Study inclusion screening form

Criteria	Assessment			Comments
Criteria	Yes	No	Unclear	Comments
Mosquito population
Did the study test Anopheles gambiae complex or Anopheles funestus group mosquitoes?	↓	—	↓	State mosquito species
Were a minimum of 50 mosquitoes tested per study arm?	↓	—	↓
Intervention
Did the study include a long‐lasting insecticidal net (LLIN) or insecticide‐treated net (ITN)?	↓	—	↓	State net LLIN or ITN
Was the intervention net either of the following? A piperonyl butoxide (PBO) LLIN that received a minimum of interim World Health Organization (WHO) approval.	↓	—	↓	State net type
Was the control net either of the following? A pyrethroid LLIN of the same fabric impregnated with the same insecticide and dose as the intervention net. A pyrethroid LLIN impregnated with the same insecticide at any dose.	↓	—	↓	State which objective study meets
Study design
Was the study one of the following? Experimental hut study Village trial	↓	—	↓	State study type
For experimental hut study and village trial. Was the study conducted in Africa?	↓	—	↓	State country
Outcome
Did the study include at least 1 of the following outcome measures? Mortality Blood feeding Sporozoite rate Not passed through the net Deterrence Exophily Mosquito density Parity rate	↓	—	↓
Decision
Is the study eligible for inclusion?	—	—	↓	State reason(s) for exclusion
Is the study eligible for inclusion?	Discuss with authors			State reason(s) for exclusion
ITN: insecticide‐treated net; LLIN: long‐lasting insecticidal net; PBO: piperonyl butoxide; WHO: World Health Organization.

Table 6. Study inclusion screening form

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Table 7. Experimental hut trials: deterrence data

Study ID	Locality	Net type	Net washed	Total number in ITN hut	Total number in UTN hut	Deterrence (%) reported	Deterrence (%) calculated
Bayili 2017	Vallée du Kou	DawaPlus 2.0	No	1548	1848	16.23	16.23
Bayili 2017	Vallée du Kou	DawaPlus 2.0	Yes	2155	1848	0	‐16.61
Bayili 2017	Vallée du Kou	DawaPlus 3.0	No	1365	1848	26.13	26.14
Bayili 2017	Vallée du Kou	DawaPlus 3.0	Yes	1981	1848	0	‐7.20
Bayili 2017	Vallée du Kou	DawaPlus 4.0	No	846	1848	54.22	54.22
Bayili 2017	Vallée du Kou	DawaPlus 4.0	Yes	1646	1848	10.93	10.93
Corbel 2010	Malanville	Permanet 2.0	Yes	195	285	31.58	31.58
Corbel 2010	Malanville	Permanet 3.0	Yes	210	285	26.32	26.32
Corbel 2010	Malanville	Permanet 2.0	No	243	285	14.74	14.74
Corbel 2010	Malanville	Permanet 3.0	No	214	285	24.91	24.91
Corbel 2010	Pitoa	Permanet 2.0	Yes	310	401	22.69	22.69
Corbel 2010	Pitoa	Permanet 3.0	Yes	163	401	59.35	59.35
Corbel 2010	Pitoa	Permanet 2.0	No	105	401	73.82	73.82
Corbel 2010	Pitoa	Permanet 3.0	No	146	401	63.59	63.59
Corbel 2010	Vallée du Kou	Permanet 2.0	Yes	788	908	13.22	13.22
Corbel 2010	Vallée du Kou	Permanet 3.0	Yes	724	908	20.26	20.26
Corbel 2010	Vallée du Kou	Permanet 2.0	No	329	908	63.77	63.77
Corbel 2010	Vallée du Kou	Permanet 3.0	No	463	908	49.01	49.01
Koudou 2011	Yaokoffikro	Permanet 3.0	No	303	796	62.1	61.93
Koudou 2011	Yaokoffikro	Permanet 2.0	No	317	796	60.4	60.18
Koudou 2011	Yaokoffikro	Permanet 3.0	Yes	313	796	60.1	60.68
Koudou 2011	Yaokoffikro	Permanet 2.0	Yes	281	796	64.4	64.70
Menze 2020	Mibellon	PermaNet 2.0	No	237	390	39.2	39.2
Menze 2020	Mibellon	PermaNet 3.0	No	153	390	60.8	60.8
Menze 2020	Mibellon	Olyset Net	No	176	390	54.9	54.9
Menze 2020	Mibellon	Olyset Plus	No	199	390	49	49
Moore 2016	Ifakara	Veeralin LN	No	722	810	11	10.86
Moore 2016	Ifakara	Veeralin LN	Yes	727	810	10	10.25
Moore 2016	Ifakara	MAGNet LN	No	1070	810	0	‐32.10
Moore 2016	Ifakara	MAGNet LN	Yes	773	810	5	4.57
Moore 2016	Ifakara	Veeralin LN	No	89	170	48	47.65
Moore 2016	Ifakara	Veeralin LN	Yes	85	170	50	50.00
Moore 2016	Ifakara	MAGNet LN	No	114	170	33	32.94
Moore 2016	Ifakara	MAGNet LN	Yes	103	170	39	39.41
N'Guessan 2010	Akron	Permanet 3.0	No	128	185	31	30.81
N'Guessan 2010	Akron	Permanet 3.0	Yes	155	185	NR	16.22
N'Guessan 2010	Akron	Permanet 2.0	No	114	185	38	38.38
N'Guessan 2010	Akron	Permanet 2.0	Yes	174	185	NR	5.95
Pennetier 2013	Malanville	Olyset Plus	No	67	69	NR	2.90
Pennetier 2013	Malanville	Olyset Plus	Yes	101	69	NR	‐46.38
Pennetier 2013	Malanville	Olyset Net	No	96	69	NR	‐39.13
Pennetier 2013	Malanville	Olyset Net	Yes	124	69	NR	‐79.71
Toé 2018	Tengrela	Olyset Net	No	923	480	‐92.29	‐92.29
Toé 2018	Tengrela	Olyset Plus	No	695	480	‐44.79	‐44.79
Toé 2018	Tengrela	Permanet 2.0	No	858	480	‐78.75	‐78.75
Toé 2018	Tengrela	Permanet 3.0	No	794	480	‐65.42	‐65.42
Toé 2018	VK5	Olyset Net	No	1458	1095	‐33.15	‐33.15
Toé 2018	VK5	Olyset Plus	No	1278	1095	‐16.71	‐16.71
Toé 2018	VK5	Permanet 2.0	No	1075	1095	1.83	1.83
Toé 2018	VK5	Permanet 3.0	No	657	1095	40	40.00
Tungu 2010	Zeneti	PermaNet 3.0	No	425	723	41	41.22
Tungu 2010	Zeneti	PermaNet 2.0	No	574	723	21	20.61
Tungu 2010	Zeneti	PermaNet 3.0	Yes	558	723	23	22.82
Tungu 2010	Zeneti	PermaNet 2.0	Yes	586	723	19	18.95
ITN: insecticide‐treated net; LLIN: long‐lasting insecticidal net; NR: not reported; PBO: piperonyl butoxide; UTN: untreated net; WHO: World Health Organization.

Table 7. Experimental hut trials: deterrence data

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Table 8. Village trials: mosquito density data

Study ID	Net type	Species	Density measurement	Collection method	Baseline density	Post‐intervention density	Reduction (%)
Awolola 2014	Untreated	An gambiae s.l.	Mean number caught per house	WT, IRC	16.2	17.1	‐5.56
Awolola 2014	PermaNet 2.0	An gambiae s.l.	Mean number caught per house	WT, IRC	21.3	7.2	66.20
Awolola 2014	PermaNet 3.0	An gambiae s.l.	Mean number caught per house	WT, IRC	20.1	1.4	93.03
Cisse 2017	PermaNet 2.0	An gambiae s.l.	Resting density per room per day	IRC	‐	1.92	‐
Cisse 2017	PermaNet 3.0	An gambiae s.l.	Resting density per room per day	IRC	‐	3.05	‐
Cisse 2017	Olyset	An gambiae s.l.	Resting density per room per day	IRC	‐	3.21	‐
Cisse 2017	Olyset Plus	An gambiae s.l.	Resting density per room per day	IRC	‐	3.7	‐
Mzilahowa 2014	Olyset	An gambiae	Mean number caught per catch	PSC	‐	0.10	‐
Mzilahowa 2014	Olset Plus	An gambiae	Mean number caught per catch	PSC	‐	0.12	‐
Mzilahowa 2014	PermaNet 2.0	An gambiae	Mean number caught per catch	PSC	‐	0.13	‐
Mzilahowa 2014	PermaNet 3.0	An gambiae	Mean number caught per catch	PSC	‐	0.09	‐
Mzilahowa 2014	Olyset	An funestus	Mean number caught per catch	PSC	‐	0.08	‐
Mzilahowa 2014	Olyset Plus	An funestus	Mean number caught per catch	PSC	‐	0.16	‐
Mzilahowa 2014	PermaNet 2.0	An funestus	Mean number caught per catch	PSC	‐	0.27	‐
Mzilahowa 2014	PermaNet 3.0	An funestus	Mean number caught per catch	PSC	‐	0.13	‐
Mzilahowa 2014	Olyset	An gambiae	Mean number caught per catch	LT	‐	1.23	‐
Mzilahowa 2014	Olset Plus	An gambiae	Mean number caught per catch	LT	‐	0.27	‐
Mzilahowa 2014	PermaNet 2.0	An gambiae	Mean number caught per catch	LT	‐	0.96	‐
Mzilahowa 2014	PermaNet 3.0	An gambiae	Mean number caught per catch	LT	‐	1.44	‐
Mzilahowa 2014	Olyset	An funestus	Mean number caught per catch	LT	‐	2.02	‐
Mzilahowa 2014	Olset Plus	An funestus	Mean number caught per catch	LT	‐	2.1	‐
Mzilahowa 2014	PermaNet 2.0	An funestus	Mean number caught per catch	LT	‐	5.76	‐
Mzilahowa 2014	PermaNet 3.0	An funestus	Mean number caught per catch	LT	‐	3.76	‐
Protopopoff 2018	Olyset (2015)	Anopheles species	Mean number caught per house per night	LT	‐	2.61	‐
Protopopoff 2018	Olyset Plus (2015)	Anopheles species	Mean number caught per house per night	LT	‐	1.85	‐
Protopopoff 2018	Olyset (2016)	Anopheles species	Mean number caught per house per night	LT	‐	3.60	‐
Protopopoff 2018	Olyset Plus (2016)	Anopheles species	Mean number caught per house per night	LT	‐	2.68	‐
Staedke 2020	Permanet 2.0 (6 months)	An gambiae s.l.	Mean density per house	IRC	0.3	0.67
Staedke 2020	Permanet 3.0 (6 months)	An gambiae s.l.	Mean density per house	IRC	0.8	0.17	78.75
Staedke 2020	Olyset (6 months)	An gambiae s.l.	Mean density per house	IRC	0.3	0.81
Staedke 2020	Olyset Plus (6 months)	An gambiae s.l.	Mean density per house	IRC	0.1	0.16
Staedke 2020	Permanet 2.0 (12 months)	An gambiae s.l.	Mean density per house	IRC	0.3	1.35
Staedke 2020	Permanet 3.0 (12 months)	An gambiae s.l.	Mean density per house	IRC	0.8	0.52	35
Staedke 2020	Olyset (12 months)	An gambiae s.l.	Mean density per house	IRC	0.3	1.1
Staedke 2020	Olyset Plus (12 months)	An gambiae s.l.	Mean density per house	IRC	0.1	0.23
Staedke 2020	Permanet 2.0 (18 months)	An gambiae s.l.	Mean density per house	IRC	0.3	1.65
Staedke 2020	Permanet 3.0 (18 months)	An gambiae s.l.	Mean density per house	IRC	0.8	1.57
Staedke 2020	Olyset (18 months)	An gambiae s.l.	Mean density per house	IRC	0.3	0.66
Staedke 2020	Olyset Plus (18 months)	An gambiae s.l.	Mean density per house	IRC	0.1	0.19
Stiles‐Ocran 2013	No intervention	An gambiae s.s.	Mean number caught per village	IRC	230	79	65.65
Stiles‐Ocran 2013	Permanet 2.0	An gambiae s.s.	Mean number caught per village	IRC	39	36	7.69
Stiles‐Ocran 2013	Permanet 2.0	An gambiae s.s.	Mean number caught per village	IRC	82	45	45.12
Stiles‐Ocran 2013	Permanet 3.0	An gambiae s.s.	Mean number caught per village	IRC	77	12	84.42
Stiles‐Ocran 2013	Permanet 3.0	An gambiae s.s.	Mean number caught per village	IRC	178	15	91.57
Stiles‐Ocran 2013	No intervention	An gambiae s.s.	Mean number caught per person per night per village	Indoor & outdoor HLC	415	72	82.65
Stiles‐Ocran 2013	Permanet 2.0	An gambiae s.s.	Mean number caught per person per night per village	Indoor & outdoor HLC	33	31	6.06
Stiles‐Ocran 2013	Permanet 2.0	An gambiae s.s.	Mean number caught per person per night per village	Indoor & outdoor HLC	79	64	18.99
Stiles‐Ocran 2013	Permanet 3.0	An gambiae s.s.	Mean number caught per person per night per village	Indoor & outdoor HLC	98	19	80.61
Stiles‐Ocran 2013	Permanet 3.0	An gambiae s.s.	Mean number caught per person per night per village	Indoor & outdoor HLC	156	36	76.92
An funestus: Anopheles funestus; An gambiae: Anopheles gambiae; HLC: human landing catch; IRC: indoor resting catch; LT: light trap; PSC: pyrethrum spray catch; WT: window trap.

Table 8. Village trials: mosquito density data

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Comparison 1. Commercial pyrethroid‐PBO nets versus commercial LLINs: village trials

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Parasite prevalence (pyrethroid‐PBO nets vs non‐PBO LLINs, latest end points in RCT) Show forest plot	2		Odds Ratio (IV, Fixed, 95% CI)	0.79 [0.67, 0.95]

1.2 Parasite prevalence (pyrethroid‐PBO nets vs non‐PBO LLINs, shown at 4 different time points) Show forest plot	2		Odds Ratio (IV, Fixed, 95% CI)	Subtotals only

1.2.1 4 to 6 months	2		Odds Ratio (IV, Fixed, 95% CI)	0.74 [0.62, 0.89]
1.2.2 9 to 12 months	2		Odds Ratio (IV, Fixed, 95% CI)	0.72 [0.61, 0.86]
1.2.3 16 to 18 months	2		Odds Ratio (IV, Fixed, 95% CI)	0.88 [0.74, 1.04]
1.2.4 21 to 25 months	2		Odds Ratio (IV, Fixed, 95% CI)	0.79 [0.67, 0.95]
1.3 Mosquito sporozoite‐positive (adjusted ICC 0.1) Show forest plot	4	424	Risk Ratio (M‐H, Random, 95% CI)	0.82 [0.24, 2.75]

1.4 Mosquito parous (adjusted ICC 0.1) Show forest plot	3	220	Risk Ratio (M‐H, Random, 95% CI)	0.97 [0.82, 1.13]

Comparison 1. Commercial pyrethroid‐PBO nets versus commercial LLINs: village trials

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Comparison 2. Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Mosquito mortality (pooled) hut/night (adjusted ICC 0.1) Show forest plot	10	15614	Risk Ratio (M‐H, Random, 95% CI)	1.43 [1.26, 1.62]

2.1.1 Unwashed	10	8647	Risk Ratio (M‐H, Random, 95% CI)	1.63 [1.29, 2.05]
2.1.2 Washed	8	6967	Risk Ratio (M‐H, Random, 95% CI)	1.19 [1.04, 1.38]
2.2 Mosquito blood‐feeding success (pooled) hut/night (adjusted ICC 0.1) Show forest plot	9	12351	Risk Ratio (M‐H, Random, 95% CI)	0.75 [0.66, 0.85]

2.2.1 Unwashed	9	7261	Risk Ratio (M‐H, Random, 95% CI)	0.68 [0.57, 0.80]
2.2.2 Washed	7	5090	Risk Ratio (M‐H, Random, 95% CI)	0.87 [0.74, 1.02]
2.3 Mosquito exophily (pooled) hut/night (adjusted ICC 0.1) Show forest plot	10	13214	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.94, 1.06]

2.3.1 Unwashed	10	7699	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.91, 1.10]
2.3.2 Washed	8	5515	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.93, 1.07]
2.4 Mosquito mortality (high resistance) hut/night (adjusted ICC 0.1) Show forest plot	5	7997	Risk Ratio (M‐H, Random, 95% CI)	1.58 [1.34, 1.86]

2.4.1 Unwashed	5	4896	Risk Ratio (M‐H, Random, 95% CI)	1.84 [1.60, 2.11]
2.4.2 Washed	4	3101	Risk Ratio (M‐H, Random, 95% CI)	1.20 [0.88, 1.63]
2.5 Mosquito blood‐feeding success (high resistance) hut/night (adjusted ICC 0.1) Show forest plot	4	7134	Risk Ratio (M‐H, Random, 95% CI)	0.66 [0.57, 0.76]

2.5.1 Unwashed	4	4458	Risk Ratio (M‐H, Random, 95% CI)	0.60 [0.50, 0.71]
2.5.2 Washed	3	2676	Risk Ratio (M‐H, Random, 95% CI)	0.81 [0.72, 0.92]
2.6 Mosquito mortality (moderate resistance) hut/night (adjusted ICC 0.1) Show forest plot	2	1027	Risk Ratio (M‐H, Fixed, 95% CI)	1.47 [1.21, 1.78]

2.6.1 Unwashed	2	751	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [1.33, 2.11]
2.6.2 Washed	1	276	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.74, 1.54]
2.7 Mosquito blood‐feeding success (moderate resistance) hut/night (adjusted ICC 0.1) Show forest plot	2	1034	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.78, 1.05]

2.7.1 Unwashed	2	752	Risk Ratio (M‐H, Random, 95% CI)	0.90 [0.72, 1.11]
2.7.2 Washed	1	282	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.74, 1.13]
2.8 Mosquito mortality (low resistance) hut/night (adjusted ICC 0.1) Show forest plot	2	1970	Risk Ratio (M‐H, Random, 95% CI)	1.30 [1.09, 1.56]

2.8.1 Unwashed	2	948	Risk Ratio (M‐H, Random, 95% CI)	1.25 [0.99, 1.57]
2.8.2 Washed	2	1022	Risk Ratio (M‐H, Random, 95% CI)	1.39 [0.95, 2.04]
2.9 Mosquito blood‐feeding success (low resistance) hut/night (adjusted ICC 0.1) Show forest plot	2	1970	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.56, 1.57]

2.9.1 Unwashed	2	948	Risk Ratio (M‐H, Random, 95% CI)	0.75 [0.27, 2.11]
2.9.2 Washed	2	1022	Risk Ratio (M‐H, Random, 95% CI)	1.07 [0.49, 2.33]
2.10 Mosquito mortality (susceptible) hut/night (adjusted ICC 0.1) Show forest plot	2	1916	Risk Ratio (M‐H, Random, 95% CI)	1.05 [0.96, 1.15]

2.10.1 Unwashed	2	948	Risk Ratio (M‐H, Random, 95% CI)	1.20 [0.64, 2.26]
2.10.2 Washed	2	968	Risk Ratio (M‐H, Random, 95% CI)	1.07 [0.92, 1.25]
2.11 Mosquito blood‐feeding success (susceptible) hut/night (adjusted ICC 0.1) Show forest plot	2	1916	Risk Ratio (M‐H, Random, 95% CI)	0.87 [0.40, 1.89]

2.11.1 Unwashed	2	948	Risk Ratio (M‐H, Random, 95% CI)	0.52 [0.12, 2.22]
2.11.2 Washed	2	968	Risk Ratio (M‐H, Random, 95% CI)	1.25 [0.82, 1.91]
2.12 Mosquito mortality (high resistance/Permanet) hut/night (adjusted ICC 0.1) Show forest plot	3	2806	Risk Ratio (M‐H, Random, 95% CI)	1.59 [1.26, 2.01]

2.12.1 Not Washed	3	1877	Risk Ratio (M‐H, Random, 95% CI)	1.81 [1.56, 2.10]
2.12.2 Washed	2	929	Risk Ratio (M‐H, Random, 95% CI)	1.18 [0.61, 2.28]
2.13 Mosquito blood‐feeding success (high resistance/Permanet) hut/night (adjusted ICC 0.1) Show forest plot	2	1943	Risk Ratio (M‐H, Random, 95% CI)	0.58 [0.45, 0.76]

2.13.1 Unwashed	2	1439	Risk Ratio (M‐H, Random, 95% CI)	0.53 [0.40, 0.69]
2.13.2 Washed	1	504	Risk Ratio (M‐H, Random, 95% CI)	0.76 [0.61, 0.93]
2.14 Mosquito mortality (high resistance/Olyset) hut/night (adjusted ICC 0.1) Show forest plot	2	1410	Risk Ratio (M‐H, Random, 95% CI)	1.73 [1.51, 1.97]

2.14.1 Unwashed	2	1257	Risk Ratio (M‐H, Random, 95% CI)	1.72 [1.48, 1.99]
2.14.2 Washed	1	153	Risk Ratio (M‐H, Random, 95% CI)	1.81 [1.25, 2.61]
2.15 Mosquito blood‐feeding success (high resistance/Olyset) hut/night (adjusted ICC 0.1) Show forest plot	2	1470	Risk Ratio (M‐H, Random, 95% CI)	0.63 [0.40, 0.98]

2.15.1 Unwashed	2	1257	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.38, 1.18]
2.15.2 Washed	1	213	Risk Ratio (M‐H, Random, 95% CI)	0.50 [0.27, 0.93]

Comparison 2. Commercial pyrethroid‐PBO nets versus commercial LLINs: hut trials

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