Abstract
BackgroundConcerted effort to control malaria has had a substantial impact on the transmission of the disease in the past two decades. In areas where reduced malaria transmission is being sustained through insecticide-based vector control interventions, primarily long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), non-insecticidal complementary tools will likely be needed to push towards malaria elimination. Once interruption in local disease transmission is achieved, insecticide-based measures can be scaled down gradually and eventually phased out, saving on costs of sustaining control programs and mitigating any unintended negative health and environmental impacts posed by insecticides. These non-insecticidal methods could eventually replace insecticidal methods of vector control.House screening, a non-insecticidal method, has a long history in malaria control, but is still not widely adopted in sub-Saharan Africa. This study aims to add to the evidence base for this intervention in low transmission settings by assessing the efficacy, impact, and feasibility of house screening in areas where LLINs are conventionally used for malaria control.MethodsA two-armed, household randomized clinical trial will be conducted in Mozambique, Zambia, and Zimbabwe to evaluate whether combined the use of house screens and LLINs affords better protection against clinical malaria in children between 6 months and 13 years compared to the sole use of LLINs. Eight hundred households will be enrolled in each study area, where 400 households will be randomly assigned the intervention, house screening, and LLINs while the control households will be provided with LLINs only. Clinical malaria incidence will be estimated by actively following up one child from each household for 6 months over the malaria transmission season. Cross-sectional parasite prevalence will be estimated by testing all participating children for malaria parasites at the beginning and end of each transmission season using rapid diagnostic tests.CDC light traps and pyrethrum spray catches (PSC) will be used to sample adult mosquitoes and evaluate the impact of house screening on indoor mosquito density, species distribution, and sporozoite rates.DiscussionThis study will contribute epidemiological data on the impact of house screening on malaria transmission and assess the feasibility of its implementation on a programmatic scale.Trial registrationClinicalTrials.gov PACTR202008524310568. Registered on August 11, 2020.
Highlights
Background and rationale {6a} Insecticide-based malaria control tools have led to significant reductions in malaria transmission, morbidity, and mortality in the past two decades [1]
It is prudent that financing mechanisms for malaria control are reviewed, adjusted, and diversified to fit the endemic countries that rely on international funding [9] and sustainable novel strategies for malaria control are developed for these settings [10]
Relevant concomitant care permitted or prohibited during the trial {11d} As this study aims to assess the additional impact of house screenings to Long-lasting insecticidetreated nets (LLIN) in preventing malaria transmission, the use of indoor residual spraying (IRS) in the study target area will be prohibited
Summary
Background and rationale {6a} Insecticide-based malaria control tools have led to significant reductions in malaria transmission, morbidity, and mortality in the past two decades [1]. The GTS goal of 90% coverage with currently supported malaria interventions will fall short, leaving a significant proportion of the at-risk population unprotected This coverage gap may lead to a resurgence of malaria in regions where it had been previously been controlled and might jeopardize the elimination goal, especially in countries at the fringe of malaria transmission, like the Southern African Region [6]. Once interruption in local disease transmission is achieved, insecticide-based measures can be scaled down gradually and eventually phased out, saving on costs of sustaining control programs and mitigating any unintended negative health and environmental impacts posed by insecticides These non-insecticidal methods could eventually replace insecticidal methods of vector control. This study aims to add to the evidence base for this intervention in low transmission settings by assessing the efficacy, impact, and feasibility of house screening in areas where LLINs are conventionally used for malaria control
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