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. 2018 Jan 30;3(1):e000610.
doi: 10.1136/bmjgh-2017-000610. eCollection 2018.

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

Carlos J Chaccour  1   2 , Sergi Alonso  1   2 , Rose Zulliger  3 , Joe Wagman  4 , Abuchahama Saifodine  5 , Baltazar Candrinho  6 , Eusébio Macete  2 , Joe Brew  1 , Christen Fornadel  7 , Hidayat Kassim  8 , Lourdes Loch  9 , Charfudin Sacoor  2 , Kenyssony Varela  9 , Cara L Carty  4 , Molly Robertson  2   4 , Francisco Saute  2
Affiliations

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

Carlos J Chaccour et al. BMJ Glob Health. .

Abstract

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.

Keywords: cluster randomised trial; health economics; health policy; malaria; medical entomology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Administrative map of Mopeia.
Figure 2
Figure 2
Defining cluster limits and buffers. Voronoi tessellation for cluster definition (panel A). Panel B shows the Voronoi surface with internal buffers. Panel C shows the location of every village, as well as the core and buffer areas.
Figure 3
Figure 3
Merging clusters with same status and buffering between clusters. Panel A shows the spray and no-spray regions. Panel B shows the 1-km of internal buffer added to each spray status zone. In panel C, each household was added and colour-coded according to location regarding spray and buffer status.
Figure 4
Figure 4
Diagram from the Standard Protocol Items: Recommendations for Interventional Trials. LLIN, long-lasting insecticide-treated nets; ANC, antenatal clinics.
See this image and copyright information in PMC

References

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