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Insecticide-treated bed nets and residual indoor spraying reduce malaria in areas with low transmission: a reanalysis of the Maltrials study

Article scientifique 2023 Anglais

Résumé

Abstract Background: We reanalysed malaria incidence data from a malaria prevention study from the Rift Valley in Central Ethiopia (see https://dx.doi.org/10.1186/s12936-019-2775-1). Our objective was to investigate whether including an administrative structure within the society, which may have required consideration in our protocol or previous analysis, would provide divergent outcomes. Methods: We performed a cluster-randomised controlled trial lasting 121 weeks with 176 clusters in four groups with 6071 households with 34,548 persons: interventions combining indoor residual spraying (IRS) and insecticide-treated nets (ITNs), IRS alone, ITNs alone and routine use. The primary outcome was malaria incidence. A multilevel negative binomial regression model was employed to examine the impact of the kebele and the proximity of homes to the primary mosquito breeding sites as potential residual confounders (levels). The study also assessed whether these factors influenced the effect measures of the interventions. Results: The initial findings of our study revealed 1183 instances of malaria episodes among 1059 persons, with comparable effects observed across the four intervention groups. In the reanalysis, the results showed that both ITN+IRS (incidence rate ratio [IRR] 0.63, P<0.001) and ITN alone (IRR 0.78, P=0.011) were associated with a greater reduction in malaria cases compared to IRS (IRR 0.90; P=0.28) or the control group (reference). The combined usage of IRS with ITN yields better outcomes compared to the standalone use of ITN and surpasses the effectiveness of IRS in isolation. Conclusion: The findings indicate that implementing a combination of IRS and ITN decreased malaria incidence. Furthermore, there was an observed synergistic impact when ITN and IRS were used in combination. Considering relevant social structures as potential residual confounders is of paramount importance. Trial registration: PACTR201411000882128 (08 September 2014)

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Gari, T., Lindtjørn, B. (2023). Insecticide-treated bed nets and residual indoor spraying reduce malaria in areas with low transmission: a reanalysis of the Maltrials study. https://doi.org/10.21203/rs.3.rs-3295696/v1

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Auteur(s)

Taye Gari Bernt Lindtjørn

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