Can Indoor Residual Spraying provide additional protection against clinical malaria over current best practice?

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

Abstract

We propose to carry out a large field trial in The Gambia, West Africa, to find out whether there is any additional benefit of spraying homes with DDT in addition to the normal practice of getting everyone to sleep under bednets impregnated with long-lasting insecticides. The study will have two groups of villages: one with only treated nets and the other with both treated nets and DDT spraying. We will measure how effective the interventions are by sampling mosquitoes in the houses and measuring malaria in study children in both sets of villages. Importantly we will determine whether the vectors are likely to become resistant to the insecticides used and we will be able to determine how much it will cost to prevent cases of malaria using the DDT. This study is important since many Afircan countries, including The Gambia, are either spraying houses with DDT at present or intend to do so in the near future.

Technical Summary

A 2 armed cluster-randomised controlled trial will be conducted to assess whether DDT IRS and LLINs combined provide better protection against clinical malaria in children, aged from 6-120 months, than LLINs alone. Clinical malaria will be recorded using passive case detection and exposure to malaria parasites assessed using light and exit traps followed by detection of Anopheles gambiae species and sporozoite infection. Susceptibility of vectors to insecticides will be measured phenotypically and by biomarkers for insecticide-resistance genes. A detailed economic assessment will be made to estimate the additional cost of averting a clinical case of malaria using IRS.
 
Description IRS training
Geographic Reach Africa 
Policy Influence Type Influenced training of practitioners or researchers
Impact We carried out training programs for indoor residual spraying and the use of rapid diagnostic tests for malaria. Both programs trained local health personnel and these standards were adopted as national practice.
 
Description Proved to be a valuable case study for WHO
Geographic Reach Africa 
Policy Influence Type Membership of a guideline committee
Impact Guidance on the combined use of indoor residual spraying and long-lasting insecticidal nets is key to the successful control of malaria in sub-Saharan Africa. This study has influenced WHO's international policy for vector control.
 
Title Trial registration number - SANTE trial 
Description In this study we compared the combination of using DDT indoor residual spraying and insecticide treated nets against current best practice of using insecticide treated nets alone. 
Type Preventative Intervention - Physical/Biological risk modification
Current Stage Of Development Wide-scale adoption
Year Development Stage Completed 2013
Development Status On hold
Clinical Trial? Yes
Impact We showed that indoor residual spraying did not provide additional protection against malaria in children compared with just sleeping under an insecticide-treated bednet. 
URL http://www.controlled-trials.com/ISRCTN01738840
 
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 Fund raising 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Malaria control: end of the honeymoon? Rotary International Conference, Torquay. 12th May 2012

My talk on malaria control was rewarded with a cheque for £700 which was donated to a charity: Against malaria for buying bednets.
Year(s) Of Engagement Activity 2012
 
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 Meeting with the Gambian NMCP 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact About 12 senior members of The Gambia's National Malaria Control Programme who asked questions and entered into discussions about the study.

NMCP fully supported this work and carried out the interventions in the study.
Year(s) Of Engagement Activity 2011
 
Description NMCP update (The Gambia) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Paper Presentation
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact 10 senior members of the NMCP attended these meetings

NMCP provided support in personnel and facilitated importation of insecticides into the country. They are project partners in our research.
Year(s) Of Engagement Activity 2010,2011,2012
 
Description PCD training 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach National
Primary Audience Health professionals
Results and Impact Passive case detection of malaria by village health workers- training, support and monitoring for the SANTE Study. Presentation to Regional Health Team, Basse, Upper River Region. About 20 people were present.

Our continuous dialogue with the health team helped disseminate the findings from our work to a wider audience.
Year(s) Of Engagement Activity 2011
 
Description Planning meeting 
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 Planning meeting. Healthy housing and reducing infectious diseases, the Royal Danish Academy of Fine Arts, School of Architecture, Design and Conservation, The School of Architecture Copenhagen, Denmark, 27th January, 2018.
Year(s) Of Engagement Activity 2018
 
Description Presentation (MRC Unit) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach Local
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Presentation of trial results with MRC Unit staff.

Discussions on how to present the findings of the study.
Year(s) Of Engagement Activity 2013
 
Description Presentation (MRC Unit, Fajara) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach Local
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact 50 people attended the meeting and asked questions

This presentation helped support collaboration within the Unit
Year(s) Of Engagement Activity 2011
 
Description Presentation (MRC Unit, The Gambia) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach Local
Primary Audience Health professionals
Results and Impact 30 people attended and asked questions

This presentation engaged and informed scientists which later led to collaboration on the study.
Year(s) Of Engagement Activity 2010
 
Description Presentation (MRC Unit, The Gambia) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach Local
Primary Audience Health professionals
Results and Impact This seminar was presented to about 30 people, will helpful discussions following the presentation.

None
Year(s) Of Engagement Activity 2011
 
Description Presentation (WHO) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Health professionals
Results and Impact Presented the findings of the trial to Roll Back Malaria

Lead to a symposium at MIM so that all similar results could present their findings
Year(s) Of Engagement Activity 2013
 
Description Presentation to the Global Fund 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Our work was presented to Sarah Hoibak, a technical advisor on malaria to the Global Fund and WHO Vector Control Unit.

Findings from our work was reported to the Global Fund and WHO.
Year(s) Of Engagement Activity 2013
 
Description Presentation with SANTE team and National Malaria Control Programme 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach National
Primary Audience Participants in your research and patient groups
Results and Impact 20 people attended the presentation and engaged in discussions

This meeting resulted in successful collaboration with the National Malaria Control Programme.
Year(s) Of Engagement Activity 2011
 
Description Protocol presentation (Malaria Centre Retreat) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach National
Primary Audience Participants in your research and patient groups
Results and Impact 200 scientists attended the meeting asking questions about the study.

It helped others design similar studies
Year(s) Of Engagement Activity 2010
 
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 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