Lukole, Eliud Andrea; Cook, Jackie; Mosha, Jacklin F; Matowo, Nancy S; Kulkarni, Manisha A; Mallya, Elizabeth; Aziz, Tatu; Martin, Jacklin; Rowland, Mark; Kleinschmidt, Immo; +3 more... Manjurano, Alphaxard; Mosha, Franklin W; Protopopoff, Natacha; (2025) Community benefits of mass distribution of three types of dual-active-ingredient long-lasting insecticidal nets against malaria prevalence in Tanzania: evidence from a 3-year cluster-randomized controlled trial. BMC public health, 25 (1). 346-. ISSN 1471-2458 DOI: https://doi.org/10.1186/s12889-025-21586-x
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Abstract
BACKGROUND: Long-lasting insecticidal nets (LLINs) were once fully effective for the prevention of malaria; however, mosquitoes have developed resistance to pyrethroids, the main class of insecticides used on nets. Dual active ingredient LLINs (dual-AI LLINs) have been rolled out as an alternative to pyrethroid (PY)-only LLINs to counteract this. Understanding the minimum community usage at which these LLINs elicit an effect that also benefits non-users against malaria infection is important. METHODS: We conducted a secondary analysis of a 3-year randomized controlled trial (RCT) in 84 clusters in North-western Tanzania to evaluate the effectiveness of three dual-AI LLINs: pyriproxyfen and alpha(α)-cypermethrin, chlorfenapyr and α-cypermethrin, and the piperonyl-butoxide (PBO) and permethrin compared to α-cypermethrin only LLINs. We measured malaria infection prevalence using 5 cross-sectional surveys between 2020 and 2022. We assessed net usage at the cluster level and malaria infection in children aged from 6 months to 14 years in 45 households per cluster. The trial was registered as a clinical trial on www. CLINICALTRIALS: gov : ClinicalTrials.gov (NCT03554616) on 2018-06-13. RESULTS: A total of 22,479 children from 12,654 households were tested for malaria using rapid diagnostic tests in January 2020, 2021, & 2022 and July 2020 & 2021. Among non-users, community-level usage of > 40% of dual-AI LLIN was significantly associated with protection against malaria infection: chlorfenapyr arm (OR: 0.44 (95% CI: 0.27-0.71), p = 0.0009), PBO arm (OR: 0.55 (95% CI: 0.33-0.94), p = 0.0277) and pyriproxyfen arm (OR: 0.61 (95% CI: 0.37-0.99), p = 0.0470) compared with non-users in clusters with > 40% usage of pyrethroid-only LLINs. There were indications of some protection against malaria infection to non-users in the chlorfenapyr arm when community-level usage was ≤ 40% (OR: 0.65 (95% CI: 0.42-1.01), p = 0.0528) compared to those living in clusters with > 40% usage of pyrethroid-only LLINs. CONCLUSION: Our study demonstrated that at a community usage of 40% or more of dual-AI LLINs non-users benefited from the presence of these nets. Noticeably, even when usage was ≤ 40% in the chlorfenapyr arm, non-users were better protected than non-users in the higher coverage pyrethroid-only arm. The greater difference in malaria risk observed between users and non-users indicates that LLINs play a crucial role in providing personal protection against malaria infection for the people using the net.
Item Type | Article |
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Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology & International Health (2023-) |
Research Centre | Malaria Centre |
PubMed ID | 39875853 |
Elements ID | 235080 |
Official URL | https://doi.org/10.1186/s12889-025-21586-x |
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Filename: Lukole-etal-2025-Community-benefits-of-mass-distribution-of-three-types-of-dual-active-ingredient-long-lasting-insecticidal-nets-against-malaria-prevalence-in-Tanzania.pdf
Licence: Creative Commons: Attribution 4.0
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