Cost-effectiveness Evaluation of Vector Control Strategies in Mozambique

Summary

This study aims to provide National Malaria Control Programs (NMCP), international donors and other key stakeholders with clear evidence on the impact and cost-effectiveness of using indoor residual spraying (IRS) with a non-pyrethroid insecticide in a high malaria transmission area that has universal long-lasting insecticidal net (LLIN) coverage. This is an interventional study with IRS serving as the research intervention.

The district of Mopeia, in the province of Zambezia, Mozambique will be the study site. This is a high transmission area with a malaria parasite prevalence of 54% in children. The Ministry of Health distributed LLINs in Mopeia in 2014-2015.

The NMCP through funding from President's Malaria Initiative Africa Indoor Residual Spraying Project (PMI-AIRS) was able to cover half a district with indoor residual spraying. A simplified census took place in mid-2016 to determine the number of children five years of age and under in the district and enumerate and map the households to assist in implementation.

From the 115 villages/bairros existent in Mopeia, 86 clusters were randomized in a government randomization ceremony to either receive IRS with Actellic or maintain no IRS. The IRS was implemented through a partnership between the NMCP and PMI-AIRS according to standard operational and consent procedures. From each cluster, a cohort of 18 children five years of age and under will be followed monthly to assess malaria incidence at the community level in both IRS and non-IRS villages. There will be 774 children in the IRS villages and 774 children in the no-IRS villages (total cohort will be 1548). Additionally, the routine health centre reporting system will be strengthened to assess malaria incidence in children five years of age and under by passive case detection. Three cross sectional studies in April 2017, April 2018, and April 2019 will assess changes in net use, health seeking behaviour and malaria prevalence at the community level.

Entomological data will be collected from both IRS and non-IRS areas to assess the vector dynamics and insecticide resistance pattern of the local vector populations from sprayed and unsprayed areas. Data on the costs of the implementation as well as health-related expenditures at health system and household levels will be collected prospectively throughout the study. These costs will be determined using both health system and societal perspectives.

The incidence rate in IRS and no-IRS areas will be combined with the micro-costing data to calculate the cost per case averted at community and health facility level.

These findings will be disseminated to the NMCP and international donors and stakeholders to complement the World Health Organization (WHO) guidance on combining indoor residual spraying and long-lasting insecticidal nets.

Conditions

• Malaria

Interventions

OTHER

Actellic CS

Indoor residual spray with Actellic CS

Sponsors & Collaborators

• United States Agency for International Development (USAID)

  collaborator FED

• Abt Associates

  collaborator INDUSTRY

• Centers for Disease Control and Prevention

  collaborator FED

• Ministry of Health, Mozambique

  collaborator OTHER_GOV

• Centro de Investigacao em Saude de Manhica

  collaborator OTHER

• PATH

  lead OTHER

Principal Investigators

• Francisco Saute, Md, MSc, PhD · Centro de Investigacoes de Manhica

• Molly Robertson, MA, MPH · PATH

• Carlos Chaccour, MD, MSc, PhD · Barcelona Institute for Global Health

• Rose Zulliger, PhD · US Presidents Malaria Initiative, Centers for Disease Control and Prevention

• Abuchama Saifodine, PhD · US Presidents Malaria Initiative, USAID

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

6 Months

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2017-01-10

Primary Completion

2019-12-31

Completion

2019-12-31

Countries

• United States
• Mozambique

Study Locations