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Impact and cost-effectiveness of a lethal house lure against malaria transmission in central Côte d'Ivoire: a two-arm, cluster-randomised controlled trial

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Author(s)

  • Eleanore D. Sternberg
  • Jackie Cook
  • Ludovic P.Ahoua Alou
  • Serge Brice Assi
  • Alphonsine A. Koffi
  • Dimi T. Doudou
  • Carine J. Aoura
  • Rosine Z. Wolie
  • Welbeck A. Oumbouke
  • Eve Worrall
  • Immo Kleinschmidt
  • Raphael N'Guessan
  • Matthew B. Thomas

Department/unit(s)

Publication details

JournalThe Lancet
DateAccepted/In press - 14 Jan 2021
DatePublished (current) - 27 Feb 2021
Issue number10276
Volume397
Number of pages11
Pages (from-to)805-815
Original languageEnglish

Abstract

Background: New vector control tools are required to sustain the fight against malaria. Lethal house lures, which target mosquitoes as they attempt to enter houses to blood feed, are one approach. Here we evaluated lethal house lures consisting of In2Care (Wageningen, Netherlands) Eave Tubes, which provide point-source insecticide treatments against host-seeking mosquitoes, in combination with house screening, which aims to reduce mosquito entry. Methods: We did a two-arm, cluster-randomised controlled trial with 40 village-level clusters in central Côte d'Ivoire between Sept 26, 2016, and April 10, 2019. All households received new insecticide-treated nets at universal coverage (one bednet per two people). Suitable households within the clusters assigned to the treatment group were offered screening plus Eave Tubes, with Eave Tubes treated using a 10% wettable powder formulation of the pyrethroid β-cyfluthrin. Because of the nature of the intervention, treatment could not be masked for households and field teams, but all analyses were blinded. The primary endpoint was clinical malaria incidence recorded by active case detection over 2 years in cohorts of children aged 6 months to 10 years. This trial is registered with ISRCTN, ISRCTN18145556. Findings: 3022 houses received screening plus Eave Tubes, with an average coverage of 70% across the intervention clusters. 1300 eligible children were recruited for active case detection in the control group and 1260 in the intervention group. During the 2-year follow-up period, malaria case incidence was 2·29 per child-year (95% CI 1·97–2·61) in the control group and 1·43 per child-year (1·21–1·65) in the intervention group (hazard ratio 0·62, 95% CI 0·51–0·76; p<0·0001). Cost-effectiveness simulations suggested that screening plus Eave Tubes has a 74·0% chance of representing a cost-effective intervention, compared with existing healthcare activities in Côte d'Ivoire, and is similarly cost-effective to other core vector control interventions across sub-Saharan Africa. No serious adverse events associated with the intervention were reported during follow-up. Interpretation: Screening plus Eave Tubes can provide protection against malaria in addition to the effects of insecticide-treated nets, offering potential for a new, cost-effective strategy to supplement existing vector control tools. Additional trials are needed to confirm these initial results and further optimise Eave Tubes and the lethal house lure concept to facilitate adoption. Funding: The Bill & Melinda Gates Foundation.

Bibliographical note

© 2021, The Author(s).

Funding Information:
The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. EDS and JC had full access to all the data in the study, and EDS had final responsibility for the decision to submit for publication. In2Care (the technology provider) was involved in putting together the grant proposal to secure funding from the Bill & Melinda Gates Foundation for the trial. In2Care also installed and maintained the technology (screening plus Eave Tubes) throughout the trial. The study design, conduct, analysis, and write up was done independently of In2Care, by the authors named on the paper.

Funding Information:
EDS holds a position funded by Vestergaard. All other authors declare no competing interests.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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