Study Characteristic of Included Studies "<b>Effectiveness of Pyrethroid-Chlorfenapyr Combination Mosquito Nets as A Preventive Malaria Infection: A Systematic Review </b><b>and Meta-analysis</b>"

Malaria remains a global health challenge, with 247 million cases and 619,000 deaths in 2021, while the effectiveness of long-lasting insecticidal nets (LLINs) is increasingly threatened by widespread pyrethroid resistance in Anopheles vectors. To address this, dual-active LLINs combining pyrethroids with novel insecticides such as chlorfenapyr have been developed. This systematic review and meta-analysis, conducted according to PRISMA guidelines, searched PubMed, Cochrane Library, EBSCOhost, ScienceDirect, Sage, SpringerLink, Scopus, and ProQuest (2019–2024) for randomized controlled trials evaluating pyrethroid–chlorfenapyr LLINs. Six trials comprising 432 clusters, 585 villages, and 117,921 households in Tanzania and Benin were included. Pooled analysis demonstrated that pyrethroid–chlorfenapyr LLINs significantly reduced malaria prevalence compared with pyrethroid-only nets (OR=0.55; 95% CI: 0.36–0.83; p=0.005), with sensitivity analysis confirming robustness (OR=0.45; 95% CI: 0.37–0.54; p<0.00001). Compared with pyrethroid–pyriproxyfen nets, chlorfenapyr nets reduced prevalence (OR=0.67; 95% CI: 0.57–0.79; p<0.00001) and also outperformed pyrethroid–piperonyl butoxide nets (OR=0.56; 95% CI: 0.45–0.68; p<0.00001). While anemia outcomes were not significantly affected, entomological endpoints consistently favored pyrethroid–chlorfenapyr nets, showing lower vector density, sporozoite rates, and Entomological Inoculation Rate (EIR), with longer-lasting efficacy than comparators. Safety analysis reported no severe adverse events, and cost-effectiveness studies identified chlorfenapyr nets as the most affordable when accounting for reduced malaria treatment costs. Collectively, these findings highlight pyrethroid–chlorfenapyr LLINs as a superior, safe, and cost-efficient innovation capable of sustaining malaria control and accelerating elimination, making them a critical next-generation tool to achieve Indonesia’s Golden Vision 2045.