Effectiveness of natural predators, microbial bioinsecticides, and plant-based bioinsecticides to reduce mosquito-borne disease burden: a systematic review.

Mosquito-borne diseases are a major public health burden given the limited pharmacological options. While the adverse effects of synthetic insecticides are well documented, it is necessary to assess whether environmentally friendly interventions are effective for disease control. Although natural predators, microbial bioinsecticides and plant-based bioinsecticides have gained attention for their specificity and reduced environmental impact, no comprehensive synthesis of evidence on their effectiveness in reducing disease burden has been conducted, highlighting the need for this review. A PRISMA 2020-compliant systematic searched for literature published from 2000 to 2026 in PubMed, Cochrane, Embase, Web of Science, LILACS, and CAB Abstracts. Experimental field studies evaluating these interventions against Aedes, Anopheles, and Culex, reporting epidemiological indicators of chikungunya, dengue, Zika, lymphatic filariasis, West Nile virus, Rift Valley fever, yellow fever, malaria, or Japanese encephalitis, were eligible. Due to outcome heterogeneity, a narrative synthesis was performed instead of a meta-analysis. Eighteen studies from Asia, Africa, Central America, and South America, assessing bacterial larvicides, copepods, and larvivorous fish, were included. Only five studies performed statistical analysis to compare intervention and control groups, two of which found no significant association between the intervention and the disease outcome. The remaining sixteen reduced disease burden in intervention groups with different levels of evidence. These interventions show potential to reduce the burden of dengue, malaria, and chikungunya across diverse settings, supporting their role as promising alternative or complementary tools for disease control. Future research would benefit from more experimental designs, standardized epidemiological outcomes, and robust statistical analysis. Prospero  Registration Number CRD42024628633.