The effect of community-driven larval source management and house improvement on malaria transmission when added to the standard malaria control strategies in Malawi: a cluster-randomized controlled trial

Malaria Journal

Peter J. Diggle¹  Paula Moraga²  Michèle van Vugt³  Aurelio Di Pasquale⁴  Nicolas Maire⁴  Willem Takken⁵  Henk van den Berg⁵  Steven Gowelo⁶  Monicah M. Mburu⁶  Robert S. McCann⁷  Themba Mzilahowa⁸  William Nkhono⁹  Kamija S. Phiri⁹  Lucinda Manda-Taylor⁹  Michael G. Chipeta^1,10  Alinune N. Kabaghe^1,11  Tinashe Tizifa^1,11  Dianne J. Terlouw^1,12 

[1] CHICAS, Lancaster Medical School, Lancaster University, Lancaster, UK;CHICAS, Lancaster Medical School, Lancaster University, Lancaster, UK;Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia;Center for Tropical Medicine & Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam, The Netherlands;Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland;University of Basel, Basel, Switzerland;Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands;Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands;School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi;Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands;School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi;Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA;MAC Communicable Diseases Action Centre, College of Medicine, University of Malawi, Blantyre, Malawi;School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi;School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi;CHICAS, Lancaster Medical School, Lancaster University, Lancaster, UK;Big Data Institute, University of Oxford, Oxford, UK;Malawi-Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi;School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi;Center for Tropical Medicine & Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam, The Netherlands;School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi;Malawi-Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi;Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK;

关键词: Malaria;    Larval source management;    House improvement;    Community engagement;    Cluster randomised trial;   

DOI  :  10.1186/s12936-021-03769-0

来源: Springer

【 摘 要 】

BackgroundCurrent standard interventions are not universally sufficient for malaria elimination. The effects of community-based house improvement (HI) and larval source management (LSM) as supplementary interventions to the Malawi National Malaria Control Programme (NMCP) interventions were assessed in the context of an intensive community engagement programme.MethodsThe study was a two-by-two factorial, cluster-randomized controlled trial in Malawi. Village clusters were randomly assigned to four arms: a control arm; HI; LSM; and HI + LSM. Malawi NMCP interventions and community engagement were used in all arms. Household-level, cross-sectional surveys were conducted on a rolling, 2-monthly basis to measure parasitological and entomological outcomes over 3 years, beginning with one baseline year. The primary outcome was the entomological inoculation rate (EIR). Secondary outcomes included mosquito density, Plasmodium falciparum prevalence, and haemoglobin levels. All outcomes were assessed based on intention to treat, and comparisons between trial arms were conducted at both cluster and household level.ResultsEighteen clusters derived from 53 villages with 4558 households and 20,013 people were randomly assigned to the four trial arms. The mean nightly EIR fell from 0.010 infectious bites per person (95% CI 0.006–0.015) in the baseline year to 0.001 (0.000, 0.003) in the last year of the trial. Over the full trial period, the EIR did not differ between the four trial arms (p = 0.33). Similar results were observed for the other outcomes: mosquito density and P. falciparum prevalence decreased over 3 years of sampling, while haemoglobin levels increased; and there were minimal differences between the trial arms during the trial period.ConclusionsIn the context of high insecticide-treated bed net use, neither community-based HI, LSM, nor HI + LSM contributed to further reductions in malaria transmission or prevalence beyond the reductions observed over two years across all four trial arms. This was the first trial, as far as the authors are aware, to test the potential complementary impact of LSM and/or HI beyond levels achieved by standard interventions. The unexpectedly low EIR values following intervention implementation indicated a promising reduction in malaria transmission for the area, but also limited the usefulness of this outcome for measuring differences in malaria transmission among the trial arms.Trial registration PACTR, PACTR201604001501493, Registered 3 March 2016, https://pactr.samrc.ac.za/.

【 授权许可】

CC BY