Evaluation of the effectiveness of topical repellent distributed by village health volunteer networks against Plasmodium spp. infection in Myanmar: A stepped-wedge cluster randomised trial


Autoři: Paul A. Agius aff001;  Julia C. Cutts aff001;  Win Han Oo aff001;  Aung Thi aff003;  Katherine O’Flaherty aff001;  Kyaw Zayar Aung aff001;  Htin Kyaw Thu aff001;  Poe Poe Aung aff001;  Myat Mon Thein aff001;  Nyi Nyi Zaw aff001;  Wai Yan Min Htay aff001;  Aung Paing Soe aff001;  Zahra Razook aff005;  Alyssa E. Barry aff001;  Win Htike aff001;  Angela Devine aff004;  Julie A. Simpson aff004;  Brendan S. Crabb aff001;  James G. Beeson aff001;  Naanki Pasricha aff001;  Freya J. I. Fowkes aff001
Působiště autorů: Burnet Institute, Victoria, Australia, and Yangon, Myanmar aff001;  Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia aff002;  Department of Public Health, Myanmar Ministry of Health and Sports, Nay Pyi Taw, Myanmar aff003;  Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia aff004;  Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia aff005;  Global Health Division, Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia aff006;  Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia aff007;  Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia aff008;  Central Clinical School, Monash University, Melbourne, Victoria, Australia aff009
Vyšlo v časopise: Evaluation of the effectiveness of topical repellent distributed by village health volunteer networks against Plasmodium spp. infection in Myanmar: A stepped-wedge cluster randomised trial. PLoS Med 17(8): e32767. doi:10.1371/journal.pmed.1003177
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003177

Souhrn

Background

The World Health Organization has yet to endorse deployment of topical repellents for malaria prevention as part of public health campaigns. We aimed to quantify the effectiveness of repellent distributed by the village health volunteer (VHV) network in the Greater Mekong Subregion (GMS) in reducing malaria in order to advance regional malaria elimination.

Methods and findings

Between April 2015 and June 2016, a 15-month stepped-wedge cluster randomised trial was conducted in 116 villages in Myanmar (stepped monthly in blocks) to test the effectiveness of 12% N,N-diethylbenzamide w/w cream distributed by VHVs, on Plasmodium spp. infection. The median age of participants was 18 years, approximately half were female, and the majority were either village residents (46%) or forest dwellers (40%). No adverse events were reported during the study. Generalised linear mixed modelling estimated the effect of repellent on infection detected by rapid diagnostic test (RDT) (primary outcome) and polymerase chain reaction (PCR) (secondary outcome). Overall Plasmodium infection detected by RDT was low (0.16%; 50/32,194), but infection detected by PCR was higher (3%; 419/13,157). There was no significant protection against RDT-detectable infection (adjusted odds ratio [AOR] = 0.25, 95% CI 0.004–15.2, p = 0.512). In Plasmodium-species-specific analyses, repellent protected against PCR-detectable P. falciparum (adjusted relative risk ratio [ARRR] = 0.67, 95% CI 0.47–0.95, p = 0.026), but not P. vivax infection (ARRR = 1.41, 95% CI 0.80–2.47, p = 0.233). Repellent effects were similar when delayed effects were modelled, across risk groups, and regardless of village-level and temporal heterogeneity in malaria prevalence. The incremental cost-effectiveness ratio was US$256 per PCR-detectable infection averted. Study limitations were a lower than expected Plasmodium spp. infection rate and potential geographic dilution of the intervention.

Conclusions

In this study, we observed apparent protection against new infections associated with the large-scale distribution of repellent by VHVs. Incorporation of repellent into national strategies, particularly in areas where bed nets are less effective, may contribute to the interruption of malaria transmission. Further studies are warranted across different transmission settings and populations, from the GMS and beyond, to inform WHO public health policy on the deployment of topical repellents for malaria prevention.

Trial registration

Australian and New Zealand Clinical Trials Registry (ACTRN12616001434482).

Klíčová slova:

Diagnostic medicine – Malaria – Medical risk factors – Plasmodium – Plasmodium falciparum – Polymerase chain reaction – Public and occupational health – Statistical distributions


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PLOS Medicine


2020 Číslo 8

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