RT Journal Article
SR Electronic
T1 Combination of indoor residual spraying with long-lasting insecticide-treated nets for malaria control in Zambezia, Mozambique: a cluster randomised trial and cost-effectiveness study protocol
JF BMJ Global Health
FD BMJ Publishing Group Ltd
SP e000610
DO 10.1136/bmjgh-2017-000610
VO 3
IS 1
A1 Chaccour, Carlos J
A1 Alonso, Sergi
A1 Zulliger, Rose
A1 Wagman, Joe
A1 Saifodine, Abuchahama
A1 Candrinho, Baltazar
A1 Macete, Eusébio
A1 Brew, Joe
A1 Fornadel, Christen
A1 Kassim, Hidayat
A1 Loch, Lourdes
A1 Sacoor, Charfudin
A1 Varela, Kenyssony
A1 Carty, Cara L
A1 Robertson, Molly
A1 Saute, Francisco
YR 2018
UL http://gh.bmj.com/content/3/1/e000610.abstract
AB Background Most of the reduction in malaria prevalence seen in Africa since 2000 has been attributed to vector control interventions. Yet increases in the distribution and intensity of insecticide resistance and higher costs of newer insecticides pose a challenge to sustaining these gains. Thus, endemic countries face challenging decisions regarding the choice of vector control interventions.Methods A cluster randomised trial is being carried out in Mopeia District in the Zambezia Province of Mozambique, where malaria prevalence in children under 5 is high (68% in 2015), despite continuous and campaign distribution of long-lasting insecticide-treated nets (LLINs). Study arm 1 will continue to use the standard, LLIN-based National Malaria Control Programme vector control strategy (LLINs only), while study arm 2 will receive indoor residual spraying (IRS) once a year for 2 years with a microencapsulated formulation of pirimiphos-methyl (Actellic 300 CS), in addition to the standard LLIN strategy (LLINs+IRS). Prior to the 2016 IRS implementation (the first of two IRS campaigns in this study), 146 clusters were defined and stratified per number of households. Clusters were then randomised 1:1 into the two study arms. The public health impact and cost-effectiveness of IRS intervention will be evaluated over 2 years using multiple methods: (1) monthly active malaria case detection in a cohort of 1548 total children aged 6–59 months; (2) enhanced passive surveillance at health facilities and with community health workers; (3) annual cross-sectional surveys; and (4) entomological surveillance. Prospective microcosting of the intervention and provider and societal costs will be conducted. Insecticide resistance status pattern and changes in local Anopheline populations will be included as important supportive outcomes.Discussion By evaluating the public health impact and cost-effectiveness of IRS with a non-pyrethroid insecticide in a high-transmission setting with high LLIN ownership, it is expected that this study will provide programmatic and policy-relevant data to guide national and global vector control strategies.Trial registration number NCT02910934.