Abstract

BackgroundIn common with many South East Asian countries, Malaysia is endemic for dengue. Dengue control in Malaysia is currently based on reactive vector management within 24 h of a dengue case being reported. Preventive rather than reactive vector control approaches, with combined interventions, are expected to improve the cost-effectiveness of dengue control programs. The principal objective of this cluster randomized controlled trial is to quantify the effectiveness of a preventive integrated vector management (IVM) strategy on the incidence of dengue as compared to routine vector control efforts.MethodsThe trial is conducted in randomly allocated clusters of low- and medium-cost housing located in the Federal Territory of Kuala Lumpur and Putrajaya. The IVM approach combines: targeted outdoor residual spraying with K-Othrine Polyzone, deployment of mosquito traps as auto-dissemination devices, and community engagement activities. The trial includes 300 clusters randomly allocated in a 1:1 ratio. The clusters receive either the preventive IVM in addition to the routine vector control activities or the routine vector control activities only. Epidemiological data from monthly confirmed dengue cases during the study period will be obtained from the Vector Borne Disease Sector, Malaysian Ministry of Health e-Dengue surveillance system. Entomological surveillance data will be collected in 12 clusters randomly selected from each arm.To measure the effectiveness of the IVM approach on dengue incidence, a negative binomial regression model will be used to compare the incidence between control and intervention clusters. To quantify the effect of the interventions on the main entomological outcome, ovitrap index, a modified ordinary least squares regression model using a robust standard error estimator will be used.DiscussionConsidering the ongoing expansion of dengue burden in Malaysia, setting up proactive control strategies is critical. Despite some limitations of the trial such as the use of passive surveillance to identify cases, the results will be informative for a better understanding of effectiveness of proactive IVM approach in the control of dengue. Evidence from this trial may help justify investment in preventive IVM approaches as preferred to reactive case management strategies.Trial registrationISRCTN ISRCTN81915073. Retrospectively registered on 17 April 2020.

Highlights

  • In common with many South East Asian countries, Malaysia is endemic for dengue

  • Despite some limitations of the trial such as the use of passive surveillance to identify cases, the results will be informative for a better understanding of effectiveness of proactive integrated vector management (IVM) approach in the control of dengue

  • In the absence of vaccines and therapeutics, efficient, sustainable, and cost-effective vector control programmes are considered the principal method of protection against vector-borne diseases

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Summary

Introduction

Dengue control in Malaysia is currently based on reactive vector management within 24 h of a dengue case being reported. The principal objective of this cluster randomized controlled trial is to quantify the effectiveness of a preventive integrated vector management (IVM) strategy on the incidence of dengue as compared to routine vector control efforts. The incidence of dengue in Malaysia increased from 31.6 reported cases per 100,000 inhabitants in the year 2000 to 159.7 in 2010 [4] and to 396.4 per 100,000 inhabitants in 2015 [5]. In 2010, the country spent an estimated US$73.5 million (95% confidence interval CI = US$62.0–US$86.3 million) on the national dengue vector control programme [6]. The control of dengue in Malaysia is based on rapid reactive vector management within 24 h of a dengue case being reported. Space spray has a relatively short life span compared to residual spraying [7, 8], and repeated use in a non-targeted application increases the potential of mosquitoes to develop resistance

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