Abstract
BackgroundIn Vietnam, malaria remains a problem in some remote areas located along its international borders and in the central highlands, partly due to the bionomics of the local vector, mainly found in forested areas and less vulnerable to standard control measures. Long Lasting Insecticidal Hammocks (LLIH), a tailored and user-friendly tool for forest workers, may further contribute in reducing the malaria burden. Their effectiveness was tested in a large community-based intervention trial carried out in Ninh Thuan province in Central Vietnam.Methods and FindingsThirty villages (population 18,646) were assembled in 20 clusters (1,000 individuals per cluster) that were randomly allocated to either the intervention or control group (no LLIH) after stratification according to the pre-intervention P. falciparum antibody prevalence (<30%; ≥30%). LLIH were distributed to the intervention group in December 2004. For the following 2 years, the incidence of clinical malaria and the prevalence of infection were determined by passive case detection at community level and by bi-annual malariometric surveys. A 2-fold larger effect on malaria incidence in the intervention as compared to the control group was observed. Similarly, malaria prevalence decreased more substantially in the intervention (1.6-fold greater reduction) than in the control group. Both for incidence and prevalence, a stronger and earlier effect of the intervention was observed in the high endemicity stratum. The number of malaria cases and infections averted by the intervention overall was estimated at 10.5 per 1,000 persons and 5.6/100 individuals, respectively, for the last half of 2006. In the high endemicity stratum, the impact was much higher, i.e. 29/1000 malaria cases and 15.7 infections/100 individuals averted.ConclusionsLLIH reduced malaria incidence and prevalence in this remote and forested area of Central Vietnam. As the targets of the newly-launched Global Malaria Action Plan include the 75% reduction of the global malaria cases by 2015 and eventually the elimination/eradication of malaria in the long term, LLIH may represent an additional tool for reaching such objectives, particularly in high endemicity areas where standard control tools have a modest impact, such as in remote and forested areas of Southeast Asia and possibly South America.Trial RegistrationClinicalTrials.gov NCT00853281
Highlights
The recently-launched ‘‘Global Malaria Action Plan’’ calls for a malaria-free world, renewing for the first time since the global malaria eradication campaign was abandoned in the early 70’s the hope that the elimination and eventually the eradication of malaria is achievable in the long term [1]
As the targets of the newly-launched Global Malaria Action Plan include the 75% reduction of the global malaria cases by 2015 and eventually the elimination/eradication of malaria in the long term, Long Lasting Insecticidal Hammocks (LLIH) may represent an additional tool for reaching such objectives, in high endemicity areas where standard control tools have a modest impact, such as in remote and forested areas of Southeast Asia and possibly South America
In March 2004, the study population included 18,646 individuals; intervention and control groups were comparable for a series of socio-demographic characteristics and bed net use, which was over 90% when considering untreated bed nets, and over 70% among people sleeping in the forest when considering both insecticidetreated bed nets (ITNs) alone or ITN and use of traditional hammock (Table 1)
Summary
The recently-launched ‘‘Global Malaria Action Plan’’ calls for a malaria-free world, renewing for the first time since the global malaria eradication campaign was abandoned in the early 70’s the hope that the elimination and eventually the eradication of malaria is achievable in the long term [1]. Vietnam has been extremely successful in controlling malaria; in 2000, malaria mortality had decreased since 1991 by 97%; by 2007, only 70,910 malaria cases and 20 malaria deaths were reported in a country of 80 million people, a 93.5% and 99.6% decrease compared to 1991 [2] Despite these successes, malaria remains an important disease along international borders with. Long Lasting Insecticidal Hammocks (LLIH), a tailored and user-friendly tool for forest workers, may further contribute in reducing the malaria burden.
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