Reducing the Burden of Malaria by Targeting Hotspots of Malaria Transmission

Summary

In this study, the investigators propose to determine the value of rolling out four targeted malaria control efforts in reducing overall malaria transmission. These targeted control efforts include local upscaling of IRS and ITNs in hotspots of malaria transmission. In addition, larviciding will be employed to target malaria vectors, also those that are less susceptible to IRS and ITNs as a consequence of outdoor feeding and resting. Lastly, the human infectious reservoir will be reduced in hotspots of malaria transmission by treating parasite carriers and their household members with the current first-line antimalarial drug. The impact of these targeted interventions on overall transmission intensity will be assessed in the context of currently ongoing malaria control activities in a plausibility study. Hotspots of malaria transmission are defined in an area of 100km2 and randomized to receive hotspot targeted interventions and compared with their baseline and with control clusters where the routine (untargeted) malaria control activities continue. The interventions will be evaluated based on changes in parasite prevalence measured in community surveys inside and outside hotspots of malaria transmission. Parasite prevalence will be compared before and after the intervention in intervention clusters and between intervention and control clusters.

In addition to malaria surveys in the human population, an entomological evaluation will take place where the densities of mosquito larvae and adult mosquitoes are monitored longitudinally.

Conditions

• Malaria

Interventions

DRUG

Artemether-lumefantrine combination

Focal screening and treatment in all households in malaria hotspots prior to the peak transmission season. Screening of a sentinel age group by rapid diagnostic tests; all parasitaemic individuals and household members of parasitaemic individuals will be treated.

BIOLOGICAL

Bacillus thuringiensis

Treatment of all waterbodies within hotspots with Bti or Bs on weekly basis

BIOLOGICAL

Long lasting insecticide treated net (LLINs)

Distribution of LLINs in all households in malaria hotspots; instruction about correct use.

BIOLOGICAL

Indoor Residual Spraying (IRS)

6-monthly IRS with deltamethrin in all households malaria hotspots.

Sponsors & Collaborators

• London School of Hygiene and Tropical Medicine

  collaborator OTHER

• Kenya Medical Research Institute

  collaborator OTHER

• Centers for Disease Control and Prevention

  collaborator FED

• International Centre of Insect Physiology and Ecology (ICIPE)

  collaborator OTHER

• Division of Malaria Control, Ministry of Health, Nairobi, Kenya

  collaborator UNKNOWN

• Radboud University Medical Center

  lead OTHER

Principal Investigators

• Teun Bousema, PhD · Radboud University Medical Center

• Jon Cox, PhD · London School of Hygiene and Tropical Medicine

• Jennifer Stevenson, PhD · London School of Hygiene and Tropical Medicine

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

6 Months

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2012-04-30

Primary Completion

2012-11-30

Completion

2012-11-30

Countries

• Kenya