To assess whether indoor residual spraying can provide additional protection against clinical malaria over current best practice of long-lasting insecticidal mosquito nets in The Gambia: study protocol for a two-armed cluster-randomised trial.

Margaret Pinder,Kalifa Bojang,Steve W Lindsay,David J Conway,Musa Jawara,Jenny Mueller,Manuel F Lluberas,David Parker,David Jeffries,Lamin Bs Jarju,Ballah Kandeh

doi:10.1186/1745-6215-12-147

Margaret Pinder, Kalifa Bojang + Show 9 more

Open Access

https://doi.org/10.1186/1745-6215-12-147

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Abstract

BackgroundRecently, there has been mounting interest in scaling-up vector control against malaria in Africa. It needs to be determined if indoor residual spraying (IRS with DDT) will provide significant marginal protection against malaria over current best practice of long-lasting insecticidal nets (LLINs) and prompt treatment in a controlled trial, given that DDT is currently the most persistent insecticide for IRS.MethodsA 2 armed cluster-randomised controlled trial will be conducted to assess whether DDT IRS and LLINs combined provide better protection against clinical malaria in children than LLINs alone in rural Gambia. Each cluster will be a village, or a group of small adjacent villages; all clusters will receive LLINs and half will receive IRS in addition. Study children, aged 6 months to 13 years, will be enrolled from all clusters and followed for clinical malaria using passive case detection to estimate malaria incidence for 2 malaria transmission seasons in 2010 and 2011. This will be the primary endpoint. Exposure to malaria parasites will be assessed using light and exit traps followed by detection of Anopheles gambiae species and sporozoite infection. Study children will be surveyed at the end of each transmission season to estimate the prevalence of Plasmodium falciparum infection and the prevalence of anaemia.DiscussionPractical issues concerning intervention implementation, as well as the potential benefits and risks of the study, are discussed.Trial RegistrationISRCTN01738840 - Spraying And Nets Towards malaria Elimination (SANTE)

Highlights

There has been mounting interest in scaling-up vector control against malaria in Africa
This study evaluates the efficacy of the 2 most common vector control tools used for malaria control: Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs)
This study sets out to examine whether there is an additional benefit of using IRS in combination with LLINs compared to current best practise, the use of LLINs alone

Summary

Methods

A 2 armed cluster-randomised controlled trial will be conducted to assess whether DDT IRS and LLINs combined provide better protection against clinical malaria in children than LLINs alone in rural Gambia. Study children, aged 6 months to 13 years, will be enrolled from all clusters and followed for clinical malaria using passive case detection to estimate malaria incidence for 2 malaria transmission seasons in 2010 and 2011. Exposure to malaria parasites will be assessed using light and exit traps followed by detection of Anopheles gambiae species and sporozoite infection. Study children will be surveyed at the end of each transmission season to estimate the prevalence of Plasmodium falciparum infection and the prevalence of anaemia

Background

Methods/Design

Discussion

Findings

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