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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Combination of malaria vector control interventions in pyrethroid resistance area in Benin: A cluster randomised controlled trial
The Lancet Infectious Diseases, Volume 12, No. 8, Year 2012
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Description
Background: Malaria control efforts and elimination in Africa are being challenged by the development of resistance of parasites to antimalarial drugs and vectors to insecticides. We investigated whether the combination of long-lasting insecticidal mosquito nets (LLINs) with indoor residual spraying (IRS) or carbamate-treated plastic sheeting (CTPS) conferred enhanced protection against malaria and better management of pyrethroid-resistance in vectors than did LLINs alone. Methods: We did a cluster randomised controlled trial in 28 villages in southern Benin, west Africa. Inclusion criteria of the villages were moderate level of pyrethroid resistance in malaria vectors and minimum distance between villages of 2 km. We assessed four malaria vector control interventions: LLIN targeted coverage to pregnant women and children younger than 6 years (TLLIN, reference group), LLIN universal coverage of all sleeping units (ULLIN), TLLIN plus full coverage of carbamate-IRS applied every 8 months (TLLIN+IRS), and ULLIN plus full coverage of CTPS lined up to the upper part of the household walls (ULLIN+CTPS). The interventions were allocated to villages by a block randomisation on the basis of preliminary surveys and children of each village were randomly selected to participate with computer-generated numbers. The primary endpoint was the incidence density rate of Plasmodium falciparum clinical malaria in children younger than 6 years as was analysed by Poisson regression taking into account the effect of age and the sampling design with a generalised estimating equation approach. Clinical and parasitological information were obtained by active case detection of malaria episodes during 12 periods of 6 consecutive days scheduled at six weekly intervals and by cross-sectional surveys of asymptomatic plasmodial infections. Children or study investigators were not masked to study group. This study is registered with Current Controlled Trials, number ISRCTN07404145. Findings: Of 58 villages assessed, 28 were randomly assigned to intervention groups. 413-429 children were followed up in each intervention group for 18 months. The clinical incidence density of malaria was not reduced in the children from the ULLIN group (incidence density rate 0·95, 95% CI 0·67-1·36, p=0·79), nor in those from the TLLIN+IRS group (1·32, 0·90-1·93, p=0·15) or from the ULLIN+CTPS group (1·05, 0·75-1·48, p=0·77) compared with the reference group (TLLIN). The same trend was observed with the prevalence and parasite density of asymptomatic infections (non significant regression coefficients). Interpretation: No significant benefit for reducing malaria morbidity, infection, and transmission was reported when combining LLIN+IRS or LLIN+CTPS compared with a background of LLIN coverage. These findings are important for national malaria control programmes and should help the design of more cost-effective strategies for malaria control and elimination. Funding: Ministère Français des Affaires Etrangères et Européennes (FSP project 2006-22), Institut de Recherche pour le Développement, President's Malaria Initiative (PMI) of US Governement. © 2012 Elsevier Ltd.
Authors & Co-Authors
Corbel, Vincent
France, Montpellier
Université de Montpellier
Benin
Centre de Recherches Entomologiques de Cotonou
Akogbéto, Martin Codjo
Benin
Centre de Recherches Entomologiques de Cotonou
Damien, Georgia Barikissou
France, Montpellier
Université de Montpellier
Benin
Centre de Recherches Entomologiques de Cotonou
Djènontin, Armel
France, Montpellier
Université de Montpellier
Benin
Centre de Recherches Entomologiques de Cotonou
Chandre, Fabrice
France, Montpellier
Université de Montpellier
France, Montpellier
Laboratoire de Lutte Contre Les Insectes Nuisibles
Rogier, Christophe
Madagascar, Antananarivo
Institut Pasteur de Madagascar
France, Marseille
Unité de Recherche Sur Les Maladies Infectieuses et Tropicales Emergentes
Moiroux, Nicolas
France, Montpellier
Université de Montpellier
Benin
Centre de Recherches Entomologiques de Cotonou
Chabi, Joseph
France, Montpellier
Université de Montpellier
Benin
Centre de Recherches Entomologiques de Cotonou
Banganna, Bio
Benin
Centre de Recherches Entomologiques de Cotonou
Padonou, Gil Germain
Benin
Centre de Recherches Entomologiques de Cotonou
Henry, Marie Claire
Benin
Service de Coopération et D'actions Culturelles
Statistics
Citations: 200
Authors: 11
Affiliations: 6
Identifiers
Doi:
10.1016/S1473-3099(12)70081-6
ISSN:
14733099
e-ISSN:
14744457
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study
Study Locations
Multi-countries
Benin
Participants Gender
Female