Association between insecticide-treated bed net use and Burkitt lymphoma incidence in children in sub-Saharan Africa: a systematic review and population-level analysis

Abstract

BackgroundBurkitt lymphoma (BL) is one of the most common childhood cancers in sub-Saharan Africa and aetiologically linked to malaria. However, evidence for an effect of malaria interventions on BL is limited. The aim of this study was to investigate the potential population-level association between large-scale rollout of insecticide-treated bednets (ITNs) in sub-Saharan Africa in the 2000s and BL incidence.MethodsWe conducted a systematic review in Embase, Global Health and MEDLINE to assemble all available data on BL incidence rates in children aged 0-15 years in malaria-endemic sub-Saharan African countries between Jan 1, 1990 and Feb 27, 2023. We calculated pooled estimates of BL incidence in sub-Saharan Africa for the time periods before and after ITN introduction. We used model estimates of sub-national ITN use to assess the association between average population ITN use and childhood BL incidence rates in a negative binomial regression model.ResultsWe included 23 studies comprising 66 datapoints on BL incidence based on 5,226 cancer cases from locations with large-scale ITN use in 17 countries. BL rates were 44% (95% CI 12-64%) lower in the time period after ITN introduction compared to before. The pooled incidence rate of BL was 1.36 (95% CI 0.88-2.10) and 0.76 (95% CI 0.50-1.16) per 100,000 person-years before and after introduction of ITNs, respectively. After adjusting for potential confounders, a 1% increase in average ITN use in the population in the 10 years before BL data collection was associated with a 2% (95% CI 1-4%) reduction in BL incidence.ConclusionThese findings suggest that large-scale rollout of ITNs in the 2000s was associated with a reduction in childhood BL burden in sub-Saharan Africa. Although published data may not be representative of all incidence rates across sub-Saharan Africa, our study highlights a potential additional benefit of malaria control programmes.