scholarly journals Risk of Plasmodium falciparum infection in south-west Burkina Faso - potential impact of expanding eligibility for seasonal malaria chemoprevention

2021 ◽  
Author(s):  
Anne L Wilson ◽  
Steve W Lindsay ◽  
Alfred Tiono ◽  
Jean Baptiste Yaro ◽  
Hilary Ranson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Plasmodium Falciparum ◽  
Burkina Faso ◽  
Malaria Transmission ◽  
Malaria Control ◽  
Control Measures ◽  
Sub Saharan Africa ◽  
South West ◽  
Seasonal Malaria Chemoprevention ◽  
The Impact

Abstract Background Burkina Faso has one of the highest malaria burdens in sub-Saharan Africa despite the mass deployment of insecticide-treated nets (ITNs) and use of seasonal malaria chemoprevention (SMC) in children aged up to 5 years. Identification of risk factors for Plasmodium falciparum infection in rural Burkina Faso could help to identify and target malaria control measures. Methods A cross-sectional survey of 1,199 children and adults was conducted during the peak malaria transmission season in south-west Burkina Faso in 2017. Logistic regression was used to identify risk factors for microscopically confirmed P. falciparum infection. A malaria transmission dynamic model was used to determine the impact on malaria cases averted of administering SMC to children aged 5–15 year old. Results P. falciparum prevalence was 32.8% in the study population. Children aged 5 to < 10 years old were at 3.74 times the odds (95% CI = 2.68–5.22, p < 0.001) and children aged 10 to 15 years old at 3.14 times the odds (95% CI = 1.20–8.21, p = 0.02) of P. falciparum infection compared to children aged less than 5 years old. Administration of SMC to children aged up to 10 years is predicted to avert an additional 57 malaria cases per 1000 population per year (9.4% reduction) and administration to children aged up to 15 years would avert an additional 89 malaria cases per 1000 population per year (14.6% reduction) in the Cascades Region, assuming coverage of pyrethroid-piperonyl butoxide ITNs. Conclusion Malaria infections were high in all age strata, although highest in children aged 5 to 15 years, despite roll out of core malaria control interventions. Given the burden of infection in school-age children, extension of the eligibility criteria for SMC could help reduce the burden of malaria in Burkina Faso and other countries in the region.

scholarly journals A cohort study to identify risk factors for Plasmodium falciparum infection in Burkinabe children: implications for other high burden high impact countries

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Jean Baptiste Yaro ◽  
Alphonse Ouedraogo ◽  
Z. Amidou Ouedraogo ◽  
Amidou Diarra ◽  
Malik Lankouande ◽  
...  
Keyword(s):  
Risk Factors ◽  
Plasmodium Falciparum ◽  
Cohort Study ◽  
Burkina Faso ◽  
Malaria Transmission ◽  
Economic Status ◽  
Control Measures ◽  
Previous Night ◽  
Transmission Season ◽  
Increased Risk

Abstract Background Progress in controlling malaria has stalled in recent years. Today the malaria burden is increasingly concentrated in a few countries, including Burkina Faso, where malaria is not declining. A cohort study was conducted to identify risk factors for malaria infection in children in southwest Burkina Faso, an area with high insecticide-treated net (ITN) coverage and insecticide-resistant vectors. Methods Incidence of Plasmodium falciparum infection was measured in 252 children aged 5 to 15 years, using active and passive detection, during the 2017 transmission season, following clearance of infection. Demographic, socio-economic, environmental, and entomological risk factors, including use of ITNs and insecticide resistance were monitored. Results During the six-month follow-up period, the overall incidence of P. falciparum infection was 2.78 episodes per child (95% CI = 2.66–2.91) by microscopy, and 3.11 (95% CI = 2.95–3.28) by polymerase chain reaction (PCR). The entomological inoculation rate (EIR) was 80.4 infective bites per child over the six-month malaria transmission season. At baseline, 80.6% of children were reported as sleeping under an ITN the previous night, although at the last survey, 23.3% of nets were in poor condition and considered no longer protective. No association was found between the rate of P. falciparum infection and either EIR (incidence rate ratio (IRR): 1.00, 95% CI: 1.00–1.00, p = 0.08) or mortality in WHO tube tests when vectors were exposed to 0.05% deltamethrin (IRR: 1.05, 95% CI: 0.73–1.50, p = 0.79). Travel history (IRR: 1.52, 95% CI: 1.45–1.59, p < 0.001) and higher socio-economic status were associated with an increased risk of P. falciparum infection (IRR: 1.05, 95% CI: 1.00–1.11, p = 0.04). Conclusions Incidence of P. falciparum infection remains overwhelmingly high in the study area. The study findings suggest that because of the exceptionally high levels of malaria transmission in the study area, malaria elimination cannot be achieved solely by mass deployment of ITNs and additional control measures are needed.

scholarly journals A cohort study to identify risk factors for Plasmodium falciparum infection in Burkinabe children: implications for other high burden high impact countries

2020 ◽  
Author(s):  
Jean Baptiste Yaro ◽  
Alphonse Ouedraogo ◽  
Z Amidou Ouedraogo ◽  
Amidou Diarra ◽  
Malik Lankouande ◽  
...  
Keyword(s):  
Risk Factors ◽  
Plasmodium Falciparum ◽  
Cohort Study ◽  
Burkina Faso ◽  
Malaria Transmission ◽  
Economic Status ◽  
Control Measures ◽  
Previous Night ◽  
Transmission Season ◽  
Increased Risk

Abstract Background Progress in controlling malaria has stalled in recent years. Today the malaria burden is increasingly concentrated in a few countries, including Burkina Faso, where malaria is not declining. A cohort study was conducted to identify risk factors for malaria infection in children in southwest Burkina Faso, an area with high insecticide-treated net (ITN) coverage and insecticide-resistant vectors.Methods Incidence of Plasmodium falciparum infection was measured in 252 children aged 5 to 15 years, using active and passive detection, during the 2017 transmission season, following clearance of infection. Demographic, socio-economic, environmental, and entomological risk factors, including use of ITNs and insecticide resistance were monitored. Results During the six-month follow-up period, the overall incidence of P. falciparum infection was 2.78 episodes per child (95% CI= 2.66-2.91) by microscopy, and 3.11 (95% CI= 2.95-3.28) by polymerase chain reaction (PCR). The entomological inoculation rate (EIR) was 80.4 infective bites per child over the six-month malaria transmission season. At baseline, 80.6% of children were reported as sleeping under an ITN the previous night, although at the last survey, 23.3% of nets were in poor condition and considered no longer protective. No association was found between the rate of P. falciparum infection and either EIR (incidence rate ratio (IRR): 1.00, 95% CI: 1.00-1.00, p=0.08) or mortality in WHO tube tests when vectors were exposed to 0.05% deltamethrin (IRR: 1.05, 95% CI: 0.73-1.50, p=0.79). Travel history (IRR: 1.52, 95% CI: 1.45-1.59, p<0.001) and higher socio-economic status were associated with an increased risk of P. falciparum infection (IRR: 1.05, 95% CI: 1.00-1.11, p=0.04).Conclusions Incidence of P. falciparum infection remains overwhelmingly high in the study area. The study findings suggest that because of the exceptionally high levels of malaria transmission in the study area, malaria elimination cannot be achieved solely by mass deployment of ITNs and additional control measures are needed.

scholarly journals A Cohort Study To Identify Risk Factors For Malaria In Burkinabe Children: Implications For Other High Burden High Impact Countries

2020 ◽  
Author(s):  
Jean Baptiste Yaro ◽  
Alphonse Ouedraogo ◽  
Z Amidou Ouedraogo ◽  
Amidou Diarra ◽  
Malik Lankouande ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Burkina Faso ◽  
Malaria Transmission ◽  
Malaria Infection ◽  
Economic Status ◽  
Control Measures ◽  
Previous Night ◽  
Transmission Season ◽  
Increased Risk

Abstract Background: Progress in controlling malaria has stalled in recent years. Today the malaria burden is increasingly concentrated in a few countries, including Burkina Faso, where malaria is not declining. We carried out a cohort study to identify risk factors for malaria infection in children in south-west Burkina Faso, an area with high insecticide-treated net (ITN) coverage and insecticide-resistant vectors.Methods: Incidence of malaria infection was measured in 252 children aged 5 to 15 years, using active and passive detection, during the 2017 transmission season, following clearance of infection. Demographic, socioeconomic, environmental and entomological risk factors, including use of ITNs and insecticide resistance were monitored. Results: During the six-month follow-up period, the overall incidence of Plasmodium falciparum infection, was 2.78 episodes per child (95% CI= 2.66-2.91) by microscopy, and 3.11 (95% CI= 2.95-3.28) by PCR. The entomological inoculation rate (EIR) was 80.4 infective bites per child over the six-month malaria transmission season. At baseline, 80.6% of children were reported as sleeping under an ITN the previous night, although at the last survey, 23.3% of nets were in poor condition and considered no longer protective. No association was found between the rate of P. falciparum infection and either EIR (Incidence Rate Ratio, IRR: 1.00, 95% CI: 1.00–1.00, p=0.08) or mortality in WHO tube tests when vectors were exposed to 0.05% deltamethrin (IRR: 1.05, 95% CI: 0.73–1.50, p=0.79). Travel history (IRR: 1.52, 95% CI: 1.45–1.59, p<0.001) and increasing socio-economic status were associated with an increased risk of P. falciparum infection (IRR: 1.05, 95% CI: 1.00–1.11, p=0.04).Conclusions: Malaria infection incidence remains overwhelmingly high in the study area. Our findings suggest that because of the exceptionally high levels of malaria transmission in the study area, malaria elimination cannot be achieved solely by mass deployment of ITNs and additional control measures are needed.

scholarly journals A cohort study to identify risk factors for malaria in Burkinabe children: implications for other high burden high impact countries

2020 ◽  
Author(s):  
Jean Baptiste Yaro ◽  
Alphonse Ouedraogo ◽  
Z Amidou Ouedraogo ◽  
Amidou Diarra ◽  
Malik Lankouande ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Burkina Faso ◽  
Malaria Transmission ◽  
Economic Status ◽  
Control Measures ◽  
Previous Night ◽  
Transmission Season ◽  
Malaria Burden ◽  
Increased Risk

Abstract Background: Progress in controlling malaria has stalled in recent years. Today the malaria burden is increasingly concentrated in a few countries, including Burkina Faso, where malaria is not declining. We carried out a cohort study to identify risk factors for malaria infection in children in south-west Burkina Faso, an area with high insecticide-treated net (ITN) coverage and insecticide-resistant vectors.Methods: Incidence of Plasmodium falciparum infection was measured in 252 children aged 5 to 15 years, using active and passive detection, during the 2017 transmission season, following clearance of infection. Demographic, socioeconomic, environmental and entomological risk factors, including use of ITNs and insecticide resistance were monitored.Results: During the six-month follow-up period, the overall incidence of P. falciparum infection, was 2.78 episodes per child (95% CI= 2.66-2.91) by microscopy, and 3.11 (95% CI= 2.95-3.28) by polymerase chain reaction. The entomological inoculation rate (EIR) was 80.4 infective bites per child over the six-month malaria transmission season. At baseline, 80.6% of children were reported as sleeping under an ITN the previous night, although at the last survey, 23.3% of nets were in poor condition and considered no longer protective. No association was found between the rate of P. falciparum infection and either EIR (Incidence Rate Ratio, IRR: 1.00, 95% CI: 1.00–1.00, p=0.08) or mortality in WHO tube tests when vectors were exposed to 0.05% deltamethrin (IRR: 1.05, 95% CI: 0.73–1.50, p=0.79). Travel history (IRR: 1.52, 95% CI: 1.45–1.59, p<0.001) and higher socio-economic status were associated with an increased risk of P. falciparum infection (IRR: 1.05, 95% CI: 1.00–1.11, p=0.04).Conclusions: Incidence of P. falciparum infection remains overwhelmingly high in the study area. Our findings suggest that because of the exceptionally high levels of malaria transmission in the study area, malaria elimination cannot be achieved solely by mass deployment of ITNs and additional control measures are needed.

scholarly journals Risk factors for Plasmodium falciparum infection in pregnant women in Burkina Faso: a community-based cross-sectional survey

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jean Baptiste Yaro ◽  
Alphonse Ouedraogo ◽  
Amidou Diarra ◽  
Salif Sombié ◽  
Z. Amidou Ouedraogo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Plasmodium Falciparum ◽  
Burkina Faso ◽  
Pregnant Women ◽  
Malaria Control ◽  
Dry Season ◽  
Malaria In Pregnancy ◽  
Wet Season ◽  
Cross Sectional ◽  
In Pregnancy

Abstract Background Malaria in pregnancy remains a public health problem in sub-Saharan Africa. Identifying risk factors for malaria in pregnancy could assist in developing interventions to reduce the risk of malaria in Burkina Faso and other countries in the region. Methods Two cross-sectional surveys were carried out to measure Plasmodium falciparum infection using microscopy in pregnant women in Saponé Health District, central Burkina Faso. Data were collected on individual, household and environmental variables and their association with P. falciparum infection assessed using multivariable analysis. Results A total of 356 pregnant women were enrolled in the surveys, 174 during the dry season and 182 during the wet season. The mean number of doses of sulfadoxine–pyrimethamine for Intermittent Preventive Treatment in pregnancy (IPTp-SP) was 0.4 doses during the first trimester, 1.1 doses at the second and 2.3 doses at the third. Overall prevalence of P. falciparum infection by microscopy was 15.7%; 17.8% in the dry season and 13.7% in the wet season. 88.2% of pregnant women reported sleeping under an insecticide-treated net (ITN) on the previous night. The odds of P. falciparum infection was 65% lower in women who reported using an ITN compared to those that did not use an ITN (Odds ratio, OR = 0.35, 95% CI 0.14–0.86, p = 0.02). IPTp-SP was also associated with reduced P. falciparum infection, with each additional dose of IPTp-SP reducing the odds of infection by 44% (OR = 0.56, 95% CI 0.39–0.79, p = 0.001). Literate women had a 2.54 times higher odds of P. falciparum infection compared to illiterate women (95% CI 1.31–4.91, p = 0.006). Conclusions The prevalence of P. falciparum infection among pregnant women remains high in Burkina Faso, although use of IPTp-SP and ITNs were found to reduce the odds of infection. Despite this, compliance with IPTp-SP remains far from that recommended by the National Malaria Control Programme and World Health Organization. Behaviour change communication should be strengthened to encourage compliance with protective malaria control tools during pregnancy.

scholarly journals Parasitological Indices of Malaria Transmission in Children under Fifteen Years in Two Ecoepidemiological Zones in Southwestern Burkina Faso

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Aristide S. Hien ◽  
Ibrahim Sangaré ◽  
Sanata Coulibaly ◽  
Moussa Namountougou ◽  
Léa Paré-Toé ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Malaria Transmission ◽  
Malaria Control ◽  
Future Research ◽  
Rice Area ◽  
Significant Difference ◽  
Bobo Dioulasso ◽  
Effective Decision Making ◽  
Epidemiological Profile ◽  
The Impact

Twenty years after the latest publications performed on the parasitological indices of malaria transmission in northwest of the second city of Burkina Faso, it was important to update the epidemiological profile of malaria in children under the age of 15 years. The objective of this study was to determine and compare the parasitological parameters of malaria transmission by season, area, and age in the two zones (rice and savanna) in the northwest of Bobo-Dioulasso, Burkina Faso. Overall, the results showed that there was no significant difference in the parasitological indices of malaria transmission within children under fifteen years between the rice site and the savannah site and whatever the season (P>0.05). The profound environmental modifications that occurred in the rice zone would have led to changes in vector behavior and consequently to changes in the epidemiological profile of malaria, contrary to the results obtained since the last publications. An entomological study correlated with this study is therefore necessary for effective decision-making for the malaria control in both areas. Future research must now focus on the impact that these profound environmental modifications of rice area are having on malaria control in Burkina Faso.

scholarly journals Genetic diversity of Plasmodium falciparum populations in three malaria transmission settings in Madagascar

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Fanomezantsoa Ralinoro ◽  
Tovonahary Angelo Rakotomanga ◽  
Rianasoambolanoro Rakotosaona ◽  
Danielle A. Doll Rakoto ◽  
Didier Menard ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Plasmodium Falciparum ◽  
Malaria Transmission ◽  
Nested Pcr ◽  
Drug Efficacy ◽  
Control Measures ◽  
Epidemiological Strata ◽  
Allele Specific ◽  
The Impact ◽  
Pcr Targeting

Abstract Background Assessment of the genetic diversity of Plasmodium falciparum parasites from various malaria transmission settings could help to define tailored local strategies for malaria control and elimination. Such assessments are currently scarce in Madagascar. The study presented here aimed to bridge this gap by investigating the genetic diversity of P. falciparum populations in three epidemiological strata (Equatorial, Tropical and Fringes) in Madagascar. Methods Two-hundred and sixty-six P. falciparum isolates were obtained from patients with uncomplicated malaria enrolled in clinical drug efficacy studies conducted at health centres in Tsaratanana (Equatorial stratum), Antanimbary (Tropical stratum) and Anjoma Ramartina (Fringes) in 2013 and 2016. Parasite DNA was extracted from blood samples collected before anti-malarial treatment. Plasmodium species were identified by nested PCR targeting the 18 S rRNA gene. The genetic profiles of P. falciparum parasites were defined by allele-specific nested PCR on the polymorphic regions of the msp-1 and msp-2 genes. Results Fifty-eight alleles were detected in the P. falciparum samples tested: 18 alleles for msp-1 and 40 for msp-2. K1 (62.9%, 139/221) and FC27 (69.5%, 114/164) were the principal msp-1 and msp-2 allele families detected, although the proportions of the msp-1 and msp-2 alleles varied significantly between sites. Polyclonal infections were more frequent at sites in the Equatorial stratum (69.8%) than at sites in the Tropical stratum (60.5%) or Fringes (58.1%). Population genetics analyses showed that genetic diversity was similar between sites and that parasite flow within sites was limited. Conclusions This study provides recent information about the genetic diversity of P. falciparum populations in three transmission strata in Madagascar, and valuable baseline data for further evaluation of the impact of the control measures implemented in Madagascar.

scholarly journals Evaluating the Efficacy, Impact and Feasibility of Community-based House Screening as a Complementary Malaria Control Intervention in Southern Africa: a Study Protocol for a Household Randomized Trial.

2021 ◽  
Author(s):  
Peter Onyango Sangoro ◽  
Ulrike Fillinger ◽  
Kochelani Saili ◽  
Theresia Estomih Nkya ◽  
Rose Marubu ◽  
...  
Keyword(s):  
Vector Control ◽  
Malaria Transmission ◽  
Malaria Control ◽  
Malaria Incidence ◽  
Indoor Residual Spraying ◽  
Clinical Malaria ◽  
Sub Saharan Africa ◽  
Substantial Impact ◽  
Transmission Season ◽  
The Impact

Abstract Background: Concerted effort to control malaria has had a substantial impact on 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 programmes 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. Methods: A two-armed, household randomized clinical trial will be conducted in Mozambique, Zambia and Zimbabwe to evaluate whether combined 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.Discussion: This 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 registration: This trial was retrospectively registered on 11th August 2020. Registration number PACTR202008524310568.

scholarly journals Genetic Diversity of Plasmodium Falciparum Populations in three Malaria Transmission Settings in Madagascar

2021 ◽  
Author(s):  
Fanomezantsoa Ralinoro ◽  
Tovonahary Angelo Rakotomanga ◽  
Riana Rakotosaona ◽  
Danielle A. Doll Rakoto ◽  
Didier Menard ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Plasmodium Falciparum ◽  
Malaria Transmission ◽  
Drug Efficacy ◽  
Control Measures ◽  
Health Centers ◽  
Allele Specific ◽  
Genetic Profiles ◽  
The Impact ◽  
Pcr Targeting

Abstract BackgroundThe assessment of the genetic diversity of Plasmodium falciparum parasites from various malaria transmission settings could help to define tailored and dedicated local strategies for malaria control and elimination. To date, this information is scarce in Madagascar. To fill this gap, a study aiming at investigating the genetic diversity of P. falciparum populations in three epidemiological facies (Equatorial, Tropical and Fringes) in Madagascar was conducted.MethodsTwo hundred sixty-six P. falciparum isolates were obtained from patients with uncomplicated malaria enrolled in clinical drug efficacy studies conducted in health centers at Tsaratanana (Equatorial facies), Antanimbary (Tropical facies) and Anjoma Ramartina (Fringes) in 2013 and 2016. Parasite DNA was extracted from blood samples collected prior antimalarial treatment. Plasmodium species were identified by nested-PCR targeting 18S rRNA gene. The genetic profiles of P. falciparum parasites were defined by assessing the polymorphic regions of the msp-1 and msp-2 genes using allele-specific nested-PCR.ResultsA total of 58 alleles were detected for msp-1 (18 alleles) and msp-2 (40 alleles) among P. falciparum samples tested. K1 (62.9%, 139/221) and FC27 (69.5%, 114/164) were the most predominant msp-1 and msp-2 allelic families, although the proportions of the msp-1 and msp-2 alleles varied significantly between sites. Polyclonal infections were more frequent in site located in the Equatorial facies (69.8%) compared to sites in the Tropical facies (60.5%) and Fringes (58.1%). Population genetic measures showed that the genetic diversity was similar between sites and the parasite flow within sites was limited.ConclusionThis study provides recent information on the genetic diversity of P. falciparum populations in three transmission facies in Madagascar and valuable baseline data to further evaluate the impact of the control measures implemented in Madagascar.

scholarly journals Design and methods for a quasi-experimental pilot study to evaluate the impact of dual active ingredient insecticide-treated nets on malaria burden in five regions in sub-Saharan Africa

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Adama Gansané ◽  
Baltazar Candrinho ◽  
Aimable Mbituyumuremyi ◽  
Perpetua Uhomoibhi ◽  
Sagnon NFalé ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Malaria Transmission ◽  
Malaria Control ◽  
Active Ingredient ◽  
Indoor Residual Spraying ◽  
Sub Saharan Africa ◽  
Bed Nets ◽  
Pilot Studies ◽  
Malaria Burden ◽  
The Impact

Abstract Background Vector control tools have contributed significantly to a reduction in malaria burden since 2000, primarily through insecticidal-treated bed nets (ITNs) and indoor residual spraying. In the face of increasing insecticide resistance in key malaria vector species, global progress in malaria control has stalled. Innovative tools, such as dual active ingredient (dual-AI) ITNs that are effective at killing insecticide-resistant mosquitoes have recently been introduced. However, large-scale uptake has been slow for several reasons, including higher costs and limited evidence on their incremental effectiveness and cost-effectiveness. The present report describes the design of several observational studies aimed to determine the effectiveness and cost-effectiveness of dual-AI ITNs, compared to standard pyrethroid-only ITNs, at reducing malaria transmission across a variety of transmission settings. Methods Observational pilot studies are ongoing in Burkina Faso, Mozambique, Nigeria, and Rwanda, leveraging dual-AI ITN rollouts nested within the 2019 and 2020 mass distribution campaigns in each country. Enhanced surveillance occurring in select study districts include annual cross-sectional surveys during peak transmission seasons, monthly entomological surveillance, passive case detection using routine health facility surveillance systems, and studies on human behaviour and ITN use patterns. Data will compare changes in malaria transmission and disease burden in districts receiving dual-AI ITNs to similar districts receiving standard pyrethroid-only ITNs over three years. The costs of net distribution will be calculated using the provider perspective including financial and economic costs, and a cost-effectiveness analysis will assess incremental cost-effectiveness ratios for Interceptor® G2, Royal Guard®, and piperonyl butoxide ITNs in comparison to standard pyrethroid-only ITNs, based on incidence rate ratios calculated from routine data. Conclusions Evidence of the effectiveness and cost-effectiveness of the dual-AI ITNs from these pilot studies will complement evidence from two contemporary cluster randomized control trials, one in Benin and one in Tanzania, to provide key information to malaria control programmes, policymakers, and donors to help guide decision-making and planning for local malaria control and elimination strategies. Understanding the breadth of contexts where these dual-AI ITNs are most effective and collecting robust information on factors influencing comparative effectiveness could improve uptake and availability and help maximize their impact.

Sign in / Sign up

Export Citation Format

Share Document