The purpose of the study is to determine whether long lasting insecticidal nets and indoor residual insecticide spraying, alone or in combination, are effective for controlling insecticide resistant anopheles mosquitoes for malaria prevention.
The study will assess the impact that insecticide resistance has on the effectiveness of malaria vector control tools LLIN and IRS. This is done by a cluster randomised trials of universal coverage LLINs versus universal coverage LLINs in combination with IRS, with levels of baseline insecticide resistance in the main vector balanced between the two study arms. In each cluster resistance to the insecticide used on LLINs is monitored, and malaria incidence is estimated from cluster specific cohorts of children followed up over the duration of the study. Resistance impact will be assessed from the ratio of incidence rates in clusters with high compared to those with low resistance and from a continuous measure of resistance expressed as percentage loss of mosquito mortality when exposed to insecticide in standardised WHO tests. Resistance mechanisms will be studied in subsets of study clusters.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
28,000
Application of insecticide to interior walls of domiciliary structures to kill malaria vector mosquitoes which rest on walls after taking human blood meal
Provision of LLIN to all community members in the clusters allocated to the study arm. LLIN protect individuals from bites by malaria vector mosquitoes by providing a physical barrier and insecticidal and repellent effect.
Malaria Control Programme
Wad Medani, Al Jazirah, Sudan
RECRUITINGMalaria Control Programme
Gedarif, Gedarif State, Sudan
RECRUITINGMalaria Control Programme
Kassala, Kassala, Sudan
RECRUITINGMalaria Incidence
Infection with malarial parasites determined by rapid diagnostic tests/microscopy in cohort members who report or have fever (\>37.5C)
Time frame: 3 years
Prevalence of P.falciparum Infection
Infection with plasmodial parasites (falciparum and/or vivax) in randomly selected members of the study cohort in each study cluster during the peak of the malaria transmission season by rapid diagnostic test
Time frame: 3 years
Entomological Innoculation rate
Anopheles arabiensis mosquitoes collected in sentinel clusters by light trap, window trap, clay pot and pyrethrum sheet collection and determination of sporozoite, human blood index, feeding and resting behaviour.
Time frame: Average for months Sept, Oct, Nov for years 2011, 2012, 2013
Frequency of insecticide resistance associated genotypes (kdr) in anopheles arabiensis
Molecular analysis of mosquito specimens caught in subset of clusters by pyrethrum spray collection.
Time frame: Yearly average 2011, 2012, 2013, 2014
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