Mosquito Bed Net Use and Burkitt Lymphoma Incidence in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

Importance: Burkitt lymphoma (BL) is one of the most common childhood cancers in sub-Saharan Africa and is etiologically linked to malaria. However, evidence for an effect of malaria interventions on BL is limited. Objective: To investigate the potential population-level association between large-scale rollout of insecticide-treated bed nets (ITNs) in sub-Saharan Africa in the 2000s and BL incidence. Data Sources: In this systematic review and meta-analysis, a search was conducted in the Embase, Global Health, and Medline databases and in cancer registry publications between January 1, 1990, and February 27, 2023. Study Selection: All epidemiologic studies on BL incidence rates in children and adolescents aged 0 to 15 years in sub-Saharan African countries where malaria is endemic were identified by 2 reviewers blinded to each other's decision. Data Extraction and Synthesis: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data were extracted independently by 2 reviewers, and quality was scored based on 3 predefined criteria: data collection, case ascertainment, and calculation of person-time at risk. Main Outcomes and Measures: Incidence rates of BL during childhood and mean ITN use in the population. Data were analyzed using a random-effects negative binomial regression model. Results: Of 2333 studies meeting selection criteria, 23 comprising 66 data points on BL incidence were included based on 5226 BL cases from locations with large-scale ITN use in 17 countries. Rates of BL were 44% (95% CI, 12%-64%) lower in the period after ITN introduction compared with before. The adjusted pooled incidence rates of BL were 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-percentage point increase in mean 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. Conclusions and Relevance: In this systematic review and meta-analysis, large-scale rollout of ITNs in the 2000s was associated with a reduction in BL burden among children in sub-Saharan Africa. Although published data may not be representative of all incidence rates across sub-Saharan Africa, this study highlights a potential additional benefit of malaria control programs.