The RooPfs study to assess whether improved housing provides additional protection against clinical malaria over current best practice in The Gambia: study protocol for a randomized controlled study and ancillary studies.

Margaret Pinder,Jakob Knudsen,Balla Kandeh,David Jeffries,Elisa Sicuri,Umberto D'Alessandro,Lesong Conteh,Steve W Lindsay,Musa Jawara,Caroline Jones

doi:10.1186/s13063-016-1400-7

Abstract

BackgroundIn malaria-endemic areas, residents of modern houses have less malaria than those living in traditional houses. This study will determine if modern housing provides incremental protection against clinical malaria over the current best practice of long-lasting insecticidal nets (LLINs) and prompt treatment in The Gambia, determine the incremental cost-effectiveness of the interventions, and analyze the housing market in The Gambia.Methods/designA two-armed, household, cluster-randomized, controlled study will be conducted to assess whether improved housing and LLINs combine to provide better protection against clinical malaria in children than LLINs alone in The Gambia. The unit of randomization will be the household, defined as a house and its occupants. A total of 800 households will be enrolled and will receive LLINs, and 400 will receive improved housing before clinical follow-up. One child aged 6 months to 13 years will be enrolled from each household and followed for clinical malaria using active case detection to estimate malaria incidence for two malaria transmission seasons. Episodes of clinical malaria will be the primary endpoint. Study children will be surveyed at the end of each transmission season to estimate the prevalence of Plasmodium falciparum infection, parasite density, and the prevalence of anemia. Exposure to malaria parasites will be assessed using light traps, followed by detection of Anopheles gambiae species and sporozoite infection. Ancillary economic and social science studies will undertake a cost-effectiveness analysis and use qualitative and participatory methods to explore the acceptability of the housing modifications and to design strategies for scaling-up housing interventions.DiscussionThe study is the first of its kind to measure the efficacy of housing on reducing clinical malaria, assess the incremental cost-effectiveness of improved housing, and identify mechanisms for scaling up housing interventions. Trial findings will help inform policy makers on improved housing for malaria control in sub-Saharan Africa.Trial registrationISRCTN Registry, ISRCTN02622179. Registered on 23 September 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1400-7) contains supplementary material, which is available to authorized users.

Highlights

In malaria-endemic areas, residents of modern houses have less malaria than those living in traditional houses
The study is the first of its kind to measure the efficacy of housing on reducing clinical malaria, assess the incremental cost-effectiveness of improved housing, and identify mechanisms for scaling up housing interventions
There have been considerable gains made in malaria control in sub-Saharan Africa, with malaria prevalence dropping by half, and the incidence of clinical disease falling by 40 % from 2000 to 2015 [1]

Summary

Introduction

In malaria-endemic areas, residents of modern houses have less malaria than those living in traditional houses. This study will determine if modern housing provides incremental protection against clinical malaria over the current best practice of long-lasting insecticidal nets (LLINs) and prompt treatment in The Gambia, determine the incremental cost-effectiveness of the interventions, and analyze the housing market in The Gambia. An urgent need exists to develop supplementary interventions that are not reliant on insecticides. This objective is advocated by Roll Back Malaria (RBM) and the United Nations Development Program The RBM Board [6], noting that continued progress in the fight against malaria is central to the attainment of the Sustainable Development Goals, has committed to implementing the aim through development of a work plan that reaches beyond the traditional health sector to include “environment, climate change, housing, sanitation, agriculture, education, and other sectors invested in the fight against poverty.” a growing enthusiasm exists for using housing as an intervention against malaria, as illustrated further by the new RBM workstream on malaria and housing (http://archiverbm.rollbackmalaria.org/mechanisms/vcwgWorkstream9.html)

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