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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Indoor Residual Spraying in Combination with Insecticide-Treated Nets Compared to Insecticide-Treated Nets Alone for Protection against Malaria: A Cluster Randomised Trial in Tanzania
PLoS Medicine, Volume 11, No. 4, Article e1001630, Year 2014
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Description
Background:Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) of houses provide effective malaria transmission control. There is conflicting evidence about whether it is more beneficial to provide both interventions in combination. A cluster randomised controlled trial was conducted to investigate whether the combination provides added protection compared to ITNs alone.Methods and Findings:In northwest Tanzania, 50 clusters (village areas) were randomly allocated to ITNs only or ITNs and IRS. Dwellings in the ITN+IRS arm were sprayed with two rounds of bendiocarb in 2012. Plasmodium falciparum prevalence rate (PfPR) in children 0.5-14 y old (primary outcome) and anaemia in children <5 y old (secondary outcome) were compared between study arms using three cross-sectional household surveys in 2012. Entomological inoculation rate (secondary outcome) was compared between study arms.IRS coverage was approximately 90%. ITN use ranged from 36% to 50%. In intention-to-treat analysis, mean PfPR was 13% in the ITN+IRS arm and 26% in the ITN only arm, odds ratio = 0.43 (95% CI 0.19-0.97, n = 13,146). The strongest effect was observed in the peak transmission season, 6 mo after the first IRS. Subgroup analysis showed that ITN users were additionally protected if their houses were sprayed. Mean monthly entomological inoculation rate was non-significantly lower in the ITN+IRS arm than in the ITN only arm, rate ratio = 0.17 (95% CI 0.03-1.08).Conclusions:This is the first randomised trial to our knowledge that reports significant added protection from combining IRS and ITNs compared to ITNs alone. The effect is likely to be attributable to IRS providing added protection to ITN users as well as compensating for inadequate ITN use. Policy makers should consider deploying IRS in combination with ITNs to control transmission if local ITN strategies on their own are insufficiently effective. Given the uncertain generalisability of these findings, it would be prudent for malaria control programmes to evaluate the cost-effectiveness of deploying the combination.Trial registration http://www.clinicaltrials.gov/ct2/show/NCT01697852?term=NCT01697852 Please see later in the article for the Editors' Summary. © 2014 West et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3988001/bin/pmed.1001630.s001.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3988001/bin/pmed.1001630.s002.docx
Authors & Co-Authors
West, Philippa A.
Unknown Affiliation
Protopopoff, Natacha
Unknown Affiliation
Wright, Alexandra
Unknown Affiliation
Kivaju, Zuhura
Unknown Affiliation
Tigererwa, Robinson
Unknown Affiliation
Mosha, Franklin W.
Unknown Affiliation
Kisinza, William N.W.
Unknown Affiliation
Rowland, Mark W.
Unknown Affiliation
Kleinschmidt, Immo
Unknown Affiliation
Statistics
Citations: 154
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.1371/journal.pmed.1001630
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Cross Sectional Study
Case-Control Study
Study Locations
Tanzania