Effect of combining mosquito repellent and insecticide treated net on malaria prevalence in Southern Ethiopia: a cluster-randomised trial

Wakgari Deressa, Yemane Y Yihdego, Zelalem Kebede, Esey Batisso, Agonafer Tekalegne, Getachew A Dagne, Wakgari Deressa, Yemane Y Yihdego, Zelalem Kebede, Esey Batisso, Agonafer Tekalegne, Getachew A Dagne

Abstract

Background: A mosquito repellent has the potential to prevent malaria infection, but there has been few studies demonstrating the effectiveness of combining this strategy with the highly effective long-lasting insecticidal nets (LLINs). This study aimed to determine the effect of combining community-based mosquito repellent with LLINs in the reduction of malaria.

Methods: A community-based clustered-randomised trial was conducted in 16 rural villages with 1,235 households in southern Ethiopia between September and December of 2008. The villages were randomly assigned to intervention (mosquito repellent and LLINs, eight villages) and control (LLINs alone, eight villages) groups. Households in the intervention villages received mosquito repellent (i.e., Buzz-Off petroleum jelly, essential oil blend) applied every evening. The baseline survey was followed by two follow-up surveys, at one month interval. The primary outcome was detection of Plasmodium falciparum, Plasmodium vivax, or both parasites, through microscopic examination of blood slides. Analysis was by intention to treat. Baseline imbalances and clustering at individual, household and village levels were adjusted using a generalized linear mixed model.

Results: 3,078 individuals in intervention and 3,004 in control group were enrolled into the study. Compared with the control arm, the combined use of mosquito repellent and LLINs significantly reduced malaria infection of all types over time [adjusted Odds Ratio (aOR) = 0.66; 95% CI = 0.45-0.97]. Similarly, a substantial reduction in P. falciparum malaria infection during the follow-up surveys was observed in the intervention group (aOR = 0.53, 95% CI = 0.31-0.89). The protective efficacy of using mosquito repellent and LLINs against malaria infection of both P. falciparum/P. vivax and P. falciparum was 34% and 47%, respectively.

Conclusions: Daily application of mosquito repellent during the evening followed by the use of LLINs during bedtime at community level has significantly reduced malaria infection. The finding has strong implication particularly in areas where malaria vectors feed mainly in the evening before bedtime.

Trial registration: ClinicalTrials.gov identifier: NCT01160809.

Figures

Figure 1
Figure 1
Trial profile.
Figure 2
Figure 2
Trends in the unadjusted reduction of the prevalence of malaria infection between the two groups.
Figure 3
Figure 3
Probability of malaria positive for intervention conditions over time.
Figure 4
Figure 4
Probability of falciparum malaria positive for intervention conditions over time.

References

    1. WHO. The World Malaria Report 2008. Geneva, Switzerland: WHO/HTM/GMP/2008.1; 2008.
    1. Abeku TA, Van Oortmarssen GJ, Borsboom G, De Vlas SJ, Habbema JDF. Spatial and temporal variations of malaria epidemic risk in Ethiopia: factors involved and implications. Acta Trop. 2003;87:331–340. doi: 10.1016/S0001-706X(03)00123-2.
    1. Kiszewski AE, Teklehaimanot A. A review of the clinical and epidemiologic burdens of epidemic malaria. Am J Trop Med Hyg. 2004;71(Suppl. 2):128–135.
    1. Negash K, Kebede A, Medhin A, Argaw D, Babaniyi O, Guintran JO, Delacollette C. Malaria epidemics in the highlands of Ethiopia. East Afr Med J. 2005;82:186–192.
    1. Ghebreyesus TA, Deressa W, Witten KH, Getachew A, Seboxa T. In: Epidemiology and Ecology of Health and Disease in Ethiopia. Berhane Y, Haile-Mariam D, Kloos H, editor. Addis Ababa: Shama Books; 2006. Malaria; pp. 556–576.
    1. Tulu AN. In: The ecology of health and disease in Ethiopia. Kloos H, Zein AZ, editor. Boulder: Westview Press; 1993. Malaria; pp. 341–352.
    1. Jima D, Getachew A, Bilak H, Steketee RW, Emerson PM, Graves PM, Gebre T, Reithinger R, Hwang J. the Ethiopia Malaria Indicator Survey Working Group. Malaria indicator survey 2007, Ethiopia: coverage and use of major malaria prevention and control interventions. Malar J. 2010;9:58. doi: 10.1186/1475-2875-9-58.
    1. Ministry of Health. Ethiopia National Malaria Indicator Survey 2011. Addis Ababa, Ethiopia: Federal Democratic Republic of Ethiopia; 2011.
    1. WHO. A decade of partnership and results (Roll Back Malaria Partnership Progress and Impact Series, no.7) Geneva, Switzerland: World Health Organization; 2011.
    1. WHO. Malaria Elimination: A Field Manual for Low and Moderate Endemic Countries. Geneva, Switzerland: World Health Organization; 2007.
    1. Feachem R, Sabot O. A new global malaria eradication strategy. Lancet. 2008;371:1633–1635. doi: 10.1016/S0140-6736(08)60424-9.
    1. Mendis K, Rietveld A, Warsame M, Bosman A, Greenwood B, Wernsdorfer WH. From malaria control to eradication: The WHO Perspective. Trop Med Int Health. 2009;14:802–809. doi: 10.1111/j.1365-3156.2009.02287.x.
    1. Ministry of Health. National strategic plan for malaria prevention and control in Ethiopia (2011–2015) Addis Ababa, Ethiopia: Federal Democratic Republic of Ethiopia; 2010.
    1. Baume CA, Reithinger R, Woldehanna S. Factors associated with use and non-use of mosquito nets owned in Oromia and Amhara Regional States, Ethiopia. Malar J. 2009;8:264. doi: 10.1186/1475-2875-8-264.
    1. Deressa W, Fentie G, Girma S, Reithinger R. Ownership and use of insecticide-treated nets in Oromia and Amhara Regional States of Ethiopia two years after a nationwide campaign. Trop Med Int Health. 2011;16:1552–1561. doi: 10.1111/j.1365-3156.2011.02875.x.
    1. Abose T, Ye-ebiyo Y, Olana D, Alamirew D, Beyene Y, Regassa L, Mengesha A. Re-orientation and definition of the role of malaria vector control in Ethiopia. Geneva: World Health Organization, WHO/Mal/1998.1085. WHO; 1998.
    1. Mark S, Fradin MD. Mosquitoes and mosquito repellents: A clinician’s guide. Ann Int Med. 1998;128:931–940. doi: 10.7326/0003-4819-128-11-199806010-00013.
    1. Durrheim DN, Govere JM. Malaria outbreak control in an African village by community application of ‘DEET’ mosquito repellent to ankles and feet. Med Vet Entomol. 2002;16:112–115. doi: 10.1046/j.0269-283x.2002.00349.x.
    1. Rowland M, Freeman T, Downey G, Hadi A, Saeed M. DEET mosquito repellent sold through social marketing provides personal protection against malaria in an area of all-night mosquito biting and partial coverage of insecticide-treated nets: a case–control study of effectiveness. Trop Med Int Health. 2004;9:343–350. doi: 10.1046/j.1365-3156.2003.01183.x.
    1. Rowland M, Downey G, Rab A, Freeman T, Mohammad N, Rehman H, Durrani N, Reyburn H, Curtis C, Lines J, Fayaz M. DEET mosquito repellent provides personal protection against malaria: a household randomized trial in an Afghan refugee camp in Pakistan. Trop Med Int Health. 2004;9:335–342. doi: 10.1111/j.1365-3156.2004.01198.x.
    1. Hill N, Lenglet A, Arnez AM, Carneiro I. Plant based insect repellent and insecticide-treated bed nets to protect against malaria in areas of early evening biting vectors: double blind randomized placebo controlled clinical trial in the Bolivian Amazon. BMJ. 2007;335:1023–1026. doi: 10.1136/bmj.39356.574641.55.
    1. Moore SJ, Darling ST, Sihuincha M, Padilla N, Devine GL. A low-cost repellent for malaria vectors in the Americas: results of two field trials in Guatemala and Peru. Malar J. 2007;6:101. doi: 10.1186/1475-2875-6-101.
    1. Pennetier C, Corbel V, Boko P, Odjo A, N’Guessan R, Lapied B, Hougard JM. Synergy between repellents and non-pyrethroid insecticides strongly extends the efficacy of treated nets against Anopheles gambiae. Malar J. 2007;6:38. doi: 10.1186/1475-2875-6-38.
    1. Pennetier C, Costantini C, Corbel V, Licciardi S, Dabire’ RK, Lapied B, Chandre F, Hougard JM. Synergy between repellents and organophosphates on bed nets: efficacy and behavioural response of natural free-flying An. gambiae mosquitoes. PLoS ONE. 2009;4:e7896. doi: 10.1371/journal.pone.0007896.
    1. Kweka EJ, Munga S, Mahande AM, Msangi S, Mazigo HD, Adrias AQ, Matias JR. Protective efficacy of menthol propylene glycol carbonate compared to N, N-diethyl-methylbenzamide against mosquito bites in Northern Tanzania. ParasitVectors. 2012;5:189.
    1. Central Statistical Agency. The 2007 National Census Preliminary Report for Ethiopia. Addis Ababa: Central Statistical Agency; 2008.
    1. Shargie EB, Gebre T, Ngondi J, Graves PM, Mosher AW, Emerson PM, Ejigsemahu Y, Endeshaw T, Olana D, WeldeMeskel A, Teferra A, Tadesse Z, Tilahun A, Yohannes G, Richards FO. Malaria prevalence and mosquito net coverage in Oromia and SNNPR regions of Ethiopia. BMC Public Health. 2008;8:321. doi: 10.1186/1471-2458-8-321.
    1. Hayes RJ, Bennett S. Simple sample size calculation for cluster-randomized trials. Int J Epidem. 1999;28:319–326. doi: 10.1093/ije/28.2.319.
    1. Ministry of Health. Malaria Diagnosis and Treatment: Guidelines for Health Workers in Ethiopia. 2. Addis Ababa, Ethiopia: Federal Democratic Republic of Ethiopia; 2004.
    1. Chambers RG, Gupta R, Ghebreyesus TA. Responding to the challenge to end malaria deaths in Africa. Lancet. 2008;371:1399–1401. doi: 10.1016/S0140-6736(08)60609-1.
    1. Otten M, Aregawi M, Were M, Carema C, Medin A, Bekele W, Jima D, Gausi K, Komatsu R, Korenromp E, Low-Beer D, Grabowsky M. Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment. Malar J. 2009;8:14. doi: 10.1186/1475-2875-8-14.
    1. Okumu FO, Kiware SS, Moore SJ, Killeen GF. Mathematical evaluation of community level impact of combining bed nets and indoor residual spraying upon malaria transmission in areas where the main vectors are Anopheles arabiensis mosquitoes. ParasitVectors. 2013;6:17.
    1. Hamel MJ, Otieno P, Bayoh N, Kariuki S, Were V, Marwanga D, Laserson KF, Williamson J, Slutsker LS, Gimnig J. The combination of indoor residual spraying and insecticide-treated nets provides added protection against malaria compared with insecticide-treated nets alone. Am J Trop Med Hyg. 2011;85:1080–1086. doi: 10.4269/ajtmh.2011.10-0684.
    1. Fullman N, Burstein R, Lim SS, Medlin C, Gakidou E. Nets, spray or both? The effectiveness of insecticide-treated nets and indoor residual spraying in reducing malaria morbidity and child mortality in sub-Saharan Africa. Malar J. 2013;12:62. doi: 10.1186/1475-2875-12-62.

Source: PubMed

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