***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective Systematic review s can include cluster-r and omised controlled trials ( C- RCTs ) , which require different analysis compared with st and ard individual-r and omised controlled trials . However , it is not known whether review authors follow the method ological and reporting guidance when including these trials . The aim of this study was to assess the method ological and reporting practice of Cochrane review s that included C- RCTs against criteria developed from existing guidance . Methods Criteria were developed , based on method ological literature and personal experience supervising review production and quality . Criteria were grouped into four themes : identifying , reporting , assessing risk of bias , and analysing C- RCTs . The Cochrane Data base of Systematic Review s was search ed ( 2nd December 2013 ) , and the 50 most recent review s that included C- RCTs were retrieved . Each review was then assessed using the criteria . Results The 50 review s we identified were published by 26 Cochrane Review Groups between June 2013 and November 2013 . For identifying C- RCTs , only 56 % identified that C- RCTs were eligible for inclusion in the review in the eligibility criteria . For reporting C- RCTs , only eight ( 24 % ) of the 33 review s reported the method of cluster adjustment for their included C- RCTs . For assessing risk of bias , only one review assessed all five C- RCT -specific risk-of-bias criteria . For analysing C- RCTs , of the 27 review s that presented unadjusted data , only nine ( 33 % ) provided a warning that confidence intervals may be artificially narrow . Of the 34 review s that reported data from unadjusted C- RCTs , only 13 ( 38 % ) excluded the unadjusted results from the meta-analyses . Conclusions The method ological and reporting practice s in Cochrane review s incorporating C- RCTs could be greatly improved , particularly with regard to analyses . Criteria developed as part of the current study could be used by review authors or editors to identify errors and improve the quality of published systematic review s incorporating C- RCTs Background The massive scale-up of insecticide-treated nets ( ITNs ) and indoor residual spraying ( IRS ) has led to a substantial increase in malaria vector insecticide resistance as well as in increased outdoor transmission , both of which hamper the effectiveness and efficiency of ITN and IRS . Long-lasting microbial larvicide can be a cost-effective new supplemental intervention tool for malaria control . Methods / design We will implement the long-lasting microbial larvicide intervention in 28 clusters in two counties in western Kenya . We will test FourStar controlled release larvicide ( 6 % by weight Bacillus thuringiensis israelensis and 1 % Bacillus sphaerius ) by applying FourStar controlled release granule formulation , 90-day briquettes , and 180-day briquettes in different habitat types . The primary endpoint is clinical malaria incidence rate and the secondary endpoint is malaria vector abundance and transmission intensity . The intervention will be conducted as a two-step approach . First , we will conduct a four-cluster trial ( two clusters per county , with one of the two clusters r and omly assigned to the intervention arm ) to optimize the larvicide application scheme . Second , we will conduct an open-label , cluster-r and omized trial to evaluate the effectiveness and cost-effectiveness of the larvicide . Fourteen clusters in each county will be assigned to intervention ( treatment ) or no intervention ( control ) by a block r and omization on the basis of clinical malaria incidence , vector density , and human population size per site . We will treat each treatment cluster with larvicide for three rounds at 4-month intervals , followed by no treatment for the following 8 months . Next , we will switch the control and treatment sites . The former control sites will receive three rounds of larvicide treatment at appropriate time intervals , and former treatment sites will receive no larvicide . We will monitor indoor and outdoor vector abundance using CO2-baited CDC light traps equipped with collection bottle rotators . Clinical malaria data will be aggregated from government-run malaria treatment centers . Discussion Since current first-line vector intervention methods do not target outdoor transmission and will select for higher insecticide resistance , new methods beyond bed nets and IRS should be considered . Long-lasting microbial larviciding represents a promising new tool that can target both indoor and outdoor transmission and alleviate the problem of pyrethroid resistance . It also has the potential to diminish costs by reducing larvicide reapplications . If successful , it could revolutionize malaria vector control in Africa , just as long-lasting bed nets have done . Trial registration U.S. National Institute of Health , study ID NCT02392832 . Registered on 3 February 2015 The optimization of malaria control strategies is complicated by constraints posed by local health systems , infrastructure , limited re sources , and the complex interactions between infection , disease , and treatment . The purpose of this paper is to describe the protocol of a r and omized factorial study design ed to address this research gap . This project will evaluate two malaria control interventions in Mvomero District , Tanzania : ( 1 ) a disease management strategy involving early detection and treatment by community health workers using rapid diagnostic technology ; and ( 2 ) vector control through community-supported larviciding .  Six study villages were assigned to each of four groups ( control , early detection and treatment , larviciding , and early detection and treatment plus larviciding ) . The primary endpoint of interest was change in malaria infection prevalence across the intervention groups measured during annual longitudinal cross-sectional surveys . Recurring entomological surveying , household surveying , and focus group discussion s will provide additional valuable insights . At baseline , 962 households across all 24 villages participated in a household survey ; 2,884 members from 720 of these households participated in subsequent malariometric surveying . The study design will allow us to estimate the effect sizes of different intervention mixtures . Careful documentation of our study protocol may also serve other research ers design ing field-based intervention trials Introduction The efficacy of Vectobac GR ( potency 200 ITU/mg ) , a new formulation of bacterial larvicide Bacillus thuringiensis var . israelensis Strain AM65 - 52 , was evaluated against Anopheles gambiae and Culex quinquefasciatus in simulated field and natural habitats in Benin . Methods In simulated field conditions , Vectobac GR formulation was tested at 3 dosages ( 0.6 , 0.9 , 1.2 g granules/m2 against An . gambiae and 1 , 1.5 , 2 g granules/m2 against Cx . quinquefasciatus ) according to manufacturer ’s product label recommendations . The dosage giving optimum efficacy under simulated field conditions were evaluated in the field . The efficacy of Vectobac GR in terms of emergence inhibition in simulated field conditions and of reduction of larval and pupal densities in rice fields and urban cesspits was measured following WHO guidelines for testing and evaluation of mosquito larvicides . Results Vectobac GR  caused emergence inhibition of ≥80 % until 21 [20]–[22 ] days for An . gambiae at 1.2 g/m2 dose and 28 [ 27–29 ] days for Cx . quinquefasciatus at 2 g/m2 in simulated field habitats . The efficacy  of Vectobac GR in natural habitats was for 2 to 3 days against larvae and up to 10 days against pupae . Conclusions Treatment with Vectobac GR  caused complete control of immature mosquito within 2–3 days but did not show prolonged residual action . Larviciding can be an option for malaria and filariasis vector control particularly in managing pyrethroid-resistance in African malaria vectors . Since use of larvicides among several African countries is being emphasized through Economic Community of West Africa States , their epidemiological impact should be carefully investigated Background Outdoor malaria transmission is becoming an increasingly important problem in malaria control in Africa . Larval control is a promising intervention as it can target both indoor and outdoor biting mosquitoes . However , the currently available biolarvicide formulations have a short effective duration , and consequently larval control incurs a high operational expense due to the requirement for frequent re-treatment of larval habitats . Formulations of biolarvicides with long-lasting effects is highly desired . A recently developed FourStar ® slow-release briquet formulation of Bacillus thuringiensis israelensis and Bacillus sphaericus was evaluated to test its efficacy on malaria vectors . Methods The study evaluated FourStar ™ briquets 180-days formulation under semi-natural and natural conditions to test their efficacy in reducing the mosquito population in western Kenya . The semi-natural habitats used the formulation dissolved in rainwater with appropriate concentrations , and second-instar larvae of Anopheles gambiae were introduced and the number of surviving larvae and pupae produced was recorded daily as the outcome . The briquets formulation was then tested in natural habitats for efficacy on pupal productivity reduction in highl and and lowl and sites in western Kenya . The formulation was finally tested for efficacy in reducing adult mosquito population s in r and omized clusters in western Kenya highl and . Results In semi-natural conditions , the FourStar ™ briquets 180-days formulation completely inhibited mosquito pupal production in the first 3 months , and then reduced pupal productivity by 87–98 % ( P < 0.001 ) 4–6 months after application . In natural habitats , during the first 2 months no pupae were detected from any of the treated habitats in highl and sites , and Anopheles spp . pupal density was reduced by 60–90 % in the next 3–5 months ( P < 0.001 ) . In the lowl and site , pupal productivity reduction was 100 % in the first 3 months , and 75–90 % in the next 4–5 months ( P < 0.001 ) . The r and omized cluster trial found that the application of the briquets formulation  reduced mean densities of indoor-biting mosquitoes by 76–82 % ( P < 0.001 ) and by 67–75 % ( P < 0.001 ) for outdoor-biting mosquitoes . Conclusion This study demonstrated that long-lasting biological larviciding was effective in reducing pupal productivity of larval habitats , and reducing indoor and outdoor resting mosquitoes . The study suggests that long-lasting microbial larviciding may be a promising complementary malaria vector control tool and warrants further large-scale evaluation Background The use of larval source management is not prioritized by contemporary malaria control programs in sub-Saharan Africa despite historical success . Larviciding , in particular , could be effective in urban areas where transmission is focal and accessibility to Anopheles breeding habitats is generally easier than in rural setting s. The objective of this study is to assess the effectiveness of a community-based microbial larviciding intervention to reduce the prevalence of malaria infection in Dar es Salaam , United Republic of Tanzania . Methods and Findings Larviciding was implemented in 3 out of 15 targeted wards of Dar es Salaam in 2006 after two years of baseline data collection . This intervention was subsequently scaled up to 9 wards a year later , and to all 15 targeted wards in 2008 . Continuous r and omized cluster sampling of malaria prevalence and socio-demographic characteristics was carried out during 6 survey rounds ( 2004–2008 ) , which included both cross-sectional and longitudinal data ( N = 64,537 ) . Bayesian r and om effects logistic regression models were used to quantify the effect of the intervention on malaria prevalence at the individual level . Effect size estimates suggest a significant protective effect of the larviciding intervention . After adjustment for confounders , the odds of individuals living in areas treated with larviciding being infected with malaria were 21 % lower ( Odds Ratio = 0.79 ; 95 % Credible Intervals : 0.66–0.93 ) than those who lived in areas not treated . The larviciding intervention was most effective during dry seasons and had synergistic effects with other protective measures such as use of insecticide-treated bed nets and house proofing ( i.e. , complete ceiling or window screens ) . Conclusion A large-scale community-based larviciding intervention significantly reduced the prevalence of malaria infection in urban Dar es Salaam Background Malaria control in Africa is most tractable in urban settlements yet most research has focused on rural setting s. Elimination of malaria transmission from urban areas may require larval control strategies that complement adult mosquito control using insecticide-treated nets or houses , particularly where vectors feed outdoors . Methods and Findings Microbial larvicide ( Bacillus thuringiensis var . israelensis ( Bti ) ) was applied weekly through programmatic , non-r and omized community-based , but vertically managed , delivery systems in urban Dar es Salaam , Tanzania . Continuous , r and omized cluster sampling of malaria infection prevalence and non-r and om programmatic surveillance of entomological inoculation rate ( EIR ) respectively constituted the primary and secondary outcomes surveyed within a population of approximately 612,000 residents in 15 fully urban wards covering 55 km2 .  Bti application for one year in 3 of those wards ( 17 km2 with 128,000 residents ) reduced crude annual transmission estimates ( Relative EIR [ 95 % Confidence Interval ] = 0.683 [ 0.491–0.952 ] , P = 0.024 ) but program effectiveness peaked between July and September ( Relative EIR [ CI ] = 0.354 [ 0.193 to 0.650 ] , P = 0.001 ) when 45 % ( 9/20 ) of directly observed transmission events occurred . Larviciding reduced malaria in 
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Ground larviciding for non-extensive larval habitats may have an effect on malaria transmission , and we do not know if there is an effect in large-scale aquatic habitats .
We found no studies using larviciding application techniques that could cover large aquatic habitats , such as aerial spraying using aircraft