Screening-homes to prevent malaria

Lead Research Organisation: Durham University
Department Name: Biological and Biomedical Sciences

Abstract

Malaria remains one of the world?s greatest childhood killers, causing the death of 1-2 million children annually. Malaria also causes much suffering in adults, preventing people from working and sustaining the cycle of poverty. Modern drugs and insecticides do not provide complete protection against this disease; there is concern that malaria control will be weakened as the parasite and mosquito vector evolve resistance to them. There is an urgent need to develop alternative malaria control methods that are sustainable and do not rely on chemicals. Bednets offer best practice for personal defence but do not protect the whole family and equity issues have always been a concern for coverage.

Historically, malaria was controlled in many parts of the tropics by mosquito-proofing houses with screens. This technology is now largely ignored or forgotten. In a pilot study in experimental huts we found that installing screen ceilings reduced entry by malaria mosquitoes by 78-80%. We now propose to investigate the level of protection from malarial mosquitoes that can be achieved by installing full screens or ceilings (as a less expensive alternative) in real homes for real people. The study will be based at the MRC in The Gambia and conducted in Farafenni, a sub-Sahelian town of 27,000 people.

We aim to assess whether the provision of house-screening or screen ceilings can reduce the exposure to malaria mosquitoes in the house by half; to investigate the household?s perceptions of comfort, durability and acceptability; and, in a separate study using experimental huts, to investigate the added value of impregnating the screens with insecticide.

The effect of the screens will be measured by catching mosquitoes inside houses using light traps ? a standard tool for collecting mosquitoes. These mosquitoes will then be tested to see how many carry malaria parasites. This will allow us to assess the degree of protection from infection afforded by the screens. Household members will sleep under bednets for the course of the study.

The knowledge generated will help governments, NGOs and policy makers make informed decisions on malaria control strategies. Findings from this important study will be shared with our partners in the Gambian Government and the NGO community through local workshops. The findings may warrant media attention regionally and internationally. Screening may be a welcome addition to the existing methods of malaria control that gives affordable, sustainable and long-lasting protection for the whole family.

Technical Summary

We have previously demonstrated that installing screen ceilings in experimental huts reduces house entry by Anopheles gambiae by 78-80%. We propose to investigate whether house-screening can reduce exposure to malaria mosquitoes by at least 50% in Gambian homes. A randomised-controlled trial will be conducted in Farafenni town in The Gambia to assess whether screening or installing netting ceilings to local houses can substantially reduce exposure to malaria vectors compared to current best practise. The acceptability of the interventions will be assessed through quantitative and qualitative methods. Experimental huts will be used to determine whether any additional benefit can be achieved by impregnating torn screens with insecticide.

This work is designed to allow informed, evidence-based, decision making by program managers and policy makers. This unconventional intervention could make a significant, equitable and sustainable contribution to an integrated malaria control strategy in Africa. This study aims to be a flagship project for the development of Environmental Management tools to control malaria in the tropics.

Publications

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Kirby Matt (2007) Risk factors for house-entry by malaria vectors in a rural town and satellite villages in the Gambia in AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE

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Lindsay SW (2021) Recommendations for building out mosquito-transmitted diseases in sub-Saharan Africa: the DELIVER mnemonic. in Philosophical transactions of the Royal Society of London. Series B, Biological sciences

 
Description Contributed to a RBM, UNDP & UNHabitat Postion Statement on Housing and Malaria
Geographic Reach Africa 
Policy Influence Type Citation in systematic reviews
URL http://www.rollbackmalaria.org/files/files/working-groups/VCWG/RBM%20VCWG%20Housing%20and%20Malaria%...
 
Description Mention of research during a lecture
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guidance committee
Impact Presented a talk at 4th meeting of the Conference of Parties to the UNEP-Linked Stockholm Convention on Persistent Organic Pollutants. Integrated vector Management: DDT-free vector control for the future. WHO, UNEP and GEF in collaboration with BIOVISION/ICIPE/THE MILLENNIUM INSTITUTE, Geneva, Switzerland, 6th May, 2009.
 
Description Remains the only randomised controlled trial carried out to assess the efficacy of house screening on malaria
Geographic Reach Africa 
Policy Influence Type Citation in systematic reviews
Impact This work has contributed to Roll Back Malaria establishing a workstream on malaria and housing.
URL http://archiverbm.rollbackmalaria.org/mechanisms/vcwgWorkstream9.html
 
Description WHO meeting on integrated vector management
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guidance committee
Impact Use of house screening was discussed at WHO consultation on development of a global operational plan for integrated vector management (IVM). WHO, Geneva, Switzerland, 1st-3rd December, 2008.
 
Description AVECNET African Vector Control: New Tools (12m euros across 14 participants)
Amount £1,650,346 (GBP)
Funding ID 265660 
Organisation European Commission 
Sector Public
Country European Union (EU)
Start 02/2011 
End 12/2016
 
Description Infection and Immunity Board
Amount £119,100 (GBP)
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 01/2010 
End 12/2012
 
Description International Center of Excellence for Malaria Research
Amount £523,928 (GBP)
Organisation National Institutes of Health (NIH) 
Sector Public
Country United States
Start 06/2010 
End 08/2017
 
Description RO1
Amount £1,661,000 (GBP)
Organisation National Institutes of Health (NIH) 
Sector Public
Country United States
Start 09/2009 
End 08/2014
 
Title House screening 
Description Screening houses either by providing fly-screen ceilings or full screening of the house. 
Type Preventative Intervention - Physical/Biological risk modification
Current Stage Of Development Initial development
Year Development Stage Completed 2009
Development Status On hold
Impact These simple interventions were shown to reduce anaemia by 50% in children living in rural Gambia. This is likely to translate into a significant reduction in malaria mortality in children. 
 
Title Trial registration number - House screening 
Description Screening for windows, doors and ceilings 
Type Therapeutic Intervention - Physical
Current Stage Of Development Small-scale adoption
Year Development Stage Completed 2008
Development Status Under active development/distribution
Clinical Trial? Yes
Impact House screening reduced anaemia in children by 50%. This could represent a similar reduction in mortality in children under 2 years old in sub-Saharan Africa. 
URL http://www.controlled-trials.com/ISRCTN51184253
 
Description Architecture exhibition of screened doors 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This was an exhibition showing the development of screened doors for keeping mosquitoes out whilst keeping the house cool.
Year(s) Of Engagement Activity 2018
 
Description BOVA Network Twitter presence 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact BOVA Network Twitter presence @bovanetwork
Year(s) Of Engagement Activity 2017,2018
 
Description BOVA Network website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact BOVA Network website
Year(s) Of Engagement Activity 2017,2018
URL http://www.bovanetwork.org
 
Description Booklet produced by Medical Detection Dogs on the research 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Medical Detection Dogs charity produced a booklet celebrating 10 years of research, which included a section on training dogs to detect malaria parasites in people.
Year(s) Of Engagement Activity 2018
 
Description Durham University Press release 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? Yes
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Several interviews given to local newspapers and radio stations.

Interview heard throughout NE England
Year(s) Of Engagement Activity 2009
 
Description Housing & malaria workstream for Roll Back Malaria 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The workstream has led to new collaborations and recognition of the importance of housing for malaria control.

New networks of collaborators have been created.
Year(s) Of Engagement Activity 2014
 
Description LSHTM 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Pod cast made

Follow-up by the BBC world service
Year(s) Of Engagement Activity 2009
 
Description Lancet Press release 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Press release appeared on the Lancet's website

Attracted media attention and discussion in national newspapers.
Year(s) Of Engagement Activity 2009
 
Description MRC The Gambia press release 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Press release made.

Positive feedback from the public
Year(s) Of Engagement Activity 2009
 
Description MRC UK press release 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact News piece written about the trial.

Attracted media attention.
Year(s) Of Engagement Activity 2009
 
Description Meeting with the Gambian Government 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Health professionals
Results and Impact Key members of the National Malaria Control Programme attended the talk, which sparked questions and discussion afterwards.

NMCP strongly supported this trial and were keen to collaborate in the future.
Year(s) Of Engagement Activity 2008
 
Description Membership of international policy group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Co-Chair of the 5th Housing and malaria work stream for Roll Back Malaria. Geneva, Switzerland, 7th-9th February, 2018.
Year(s) Of Engagement Activity 2018
 
Description Membership of international policy group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Co-Chair of the 5th Housing and malaria work stream for Roll Back Malaria. Geneva, Switzerland, 7th-9th February, 2018.
Year(s) Of Engagement Activity 2018
URL https://rollbackmalaria.com/wp-content/uploads/2017/08/Steve-Lindsay_Lucy-Tusting_Housing-work-strea...
 
Description Presentation 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited speaker. Urbanization and slums: new transmission pathways of infectious diseases in the built environment, The National Academies of Sciences, Engineering and Medicine, Washington, USA, 13th December, 2017.
Year(s) Of Engagement Activity 2017
 
Description School visit 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact 90 girls attended a careers talk, which sparked questions and discussions afterwards

School teachers said that this was one of the most enjoyable talks given and stimulated the students.
Year(s) Of Engagement Activity 2009
 
Description Talk 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited speaker. Under-pinning work to support studies on malaria transmission in The Gambia. 70th Anniversary of the MRC Unit The Gambia, Fajara, The Gambia, 28th November, 2017.
Year(s) Of Engagement Activity 2017
 
Description Village meetings 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Participants in your research and patient groups
Results and Impact Whole communities attended the talks, which sparked questions and discussions afterwards.

Communities asked to participate in future MRC trials.
Year(s) Of Engagement Activity 2008