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. 2022 Apr 19;149(7):1-39.
doi: 10.1017/S0031182022000415. Online ahead of print.

Effectiveness of screened ceilings over the current best practice in reducing malaria prevalence in western Kenya: a cluster randomised controlled trial

Noboru Minakawa  1 , Hitoshi Kawada  1 , James O Kongere  2   3 , George O Sonye  4 , Peter A Lutiali  2   3 , Beatrice Awuor  4 , Rie Isozumi  1 , Kyoko Futami  1
Affiliations

Effectiveness of screened ceilings over the current best practice in reducing malaria prevalence in western Kenya: a cluster randomised controlled trial

Noboru Minakawa et al. Parasitology. .

Abstract

Increases in bed net coverage and antimalarial treatment have reduced the risk of malaria in sub-Saharan Africa. However, the pace of reduction has slowed, and new tools are needed to reverse this trend. We evaluated houses screened with insecticide-treated ceiling nets using a cluster randomized-controlled trial in western Kenya. The primary endpoints were Plasmodium falciparum PCR-positive prevalence (PCRPfPR) of children from 7 months to 10 years old and anopheline density. Ceiling nets and bed nets were provided to 1073 houses, and 1162 houses were provided with bed nets only. The treatment and control arms each had four clusters. We conducted three epidemiological and entomological post-intervention surveys over the course of a year and a half. Each epidemiological survey targeted 150 children per cluster, and entomological surveys targeted 25 houses. When the three surveys were combined, the median PCRPfPRs were 23% (IQR 8%) in the intervention arm and 42% (IQR 12%) in the control arm. The adjusted risk ratio (RR) was 0.53 [95% confidence interval (CI) 0.41–0.71; P = 0.029]. The median anopheline densities were 0.4 (IQR 0.4) and 2.0 (IQR 1.4), respectively. The adjusted RR was 0.41 (95% CI 0.29–0.90; P = 0.029). The present study indicates additional protection from insecticide-screened ceilings over the current best practice.

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Conflict of interest statement

None.

Figures

None
Graphical abstract
Fig. 1.
Fig. 1.
Ceiling net. Mosquitoes that enter from the eave opening are trapped in the space between the ceiling net and roof. Olyset®Net, which is treated with permethrin, was used for the ceiling net material. The net may also kill mosquitoes that enter the room from the door and windows.
Fig. 2.
Fig. 2.
Map showing the boundaries and buffer zones between the intervention and control clusters in the study area.
Fig. 3.
Fig. 3.
Flow chart and trial profile for epidemiological surveys.
Fig. 4.
Fig. 4.
Vector densities from the sentinel house mosquito survey and two post-intervention cross-sectional surveys.
See this image and copyright information in PMC

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