Screening plus Eave Tubes provides a cost-effective strategy to alleviate burden of malaria in Côte d’Ivoire

1. Malaria case incidence was decreased in the intervention group (1.43 per child-year) compared to the control group (2.29 per child-year).

2. Screening plus Eave Tubes has a 74.0% chance of representing a cost-effective intervention for malaria protection.

Evidence Rating Level: 1 (Excellent)

Study Rundown: In recent years, wide scale implementation of core vector control has led to minimal reductions in the burden of malaria. New control strategies, such as mosquito-proofing of houses and eave-closing, may reduce indoor vector abundance. The World Health Organization (WHO) recommends creating a lethal house lure, through screening plus Eave Tubes (SET), to trap and eliminate host-seeking mosquitos. This study aimed to evaluate the epidemiological effect of SET, and its cost-effectiveness, in the presence of universal coverage of insecticide-treated nets. Primary endpoint was active malaria incidence in children aged 6 months to 10 years, while secondary endpoints included prevalence of anemia in children aged 5 years and younger. During the 2-year follow-up period, the intervention group reported a lower incidence of malaria than the control group. Similarly, screening plus Eave Tubes represented a more cost-effective intervention compared to the existing healthcare activities in Cote d’Ivoire. A major strength of this study was the large sample size for both the control and intervention groups, as well as a longitudinal follow-up of two years. Overall, this study provides valuable insight about the effectiveness of a novel strategy – SET – for malaria control and prevention.

Click to read the study in The Lancet

Relevant Reading: Epidemiologic Trends in Malaria Incidence Among Travelers Returning to Metropolitan France, 1996-2016

In-depth [randomized controlled trial]: Between Sept 26, 2016, and April 10, 2019, 3022 houses were enrolled across 40 village-level clusters in central Cote d’Ivoire. There were 4222 houses in the intervention group, of which 3021 (72%) received SET. A total of 15 052 insecticide-treated nets were distributed in the control group and 14 692 in the intervention group. Altogether, 2560 children (1300 in the control group and 1260 in the intervention group) were recruited over the 2-year period, giving a follow-up time of 3253 child-years.

The primary endpoint of malaria case incidence was lower in the intervention group (1.43 per child-year, 95% CI 1.21-1.65) than in the control group (2.29 per child-year, 95% confidence interval [CI] 1.97-2.61; hazard ratio [HR] 0.62, 95% CI 0.51-0.76, p<0.0001). The secondary endpoint concerning prevalence of anemia reduced from 38.5% (346 of 898) at baseline to 14.5% (108 of 747) 6 months later and remained similar throughout follow-up. In the intervention group, the odds of anemia were 30% lower than those living in the control group (odds ratio [OR] 0.69, 95% CI 0.49-0.99, p=0.046). An inversely proportional relationship existed between malaria incidence and SET coverage, with a 10% decrease in incidence for every 10% increase in SET coverage (HR 0.90, 95% CI 0.52-0.94, p<0.0001). Cost-effectiveness simulations suggested that screening plus Eave Tubes had a 74.0% chance of representing a cost-effective intervention, compared with existing healthcare activities in Cote d’Ivoire. In terms of treatment-related events, respiratory infections were rare, with no difference between both groups (HR 1.00, 95% CI 0.71-1.41, p=0.99). During the 2-year follow-up, 12 children died (9 in the control group, and 3 in the intervention group). Findings from this study suggest that screening plus Eave Tubes provides protection against malaria and may be used as a novel, cost-effective strategy to supplement existing vector control tools.

Image: PD

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