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
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 alter...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12889-025-21586-x |
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| author | Eliud Andrea Lukole Jackie Cook Jacklin F Mosha Nancy S Matowo Manisha A Kulkarni Elizabeth Mallya Tatu Aziz Jacklin Martin Mark Rowland Immo Kleinschmidt Alphaxard Manjurano Franklin W Mosha Natacha Protopopoff |
| author_facet | Eliud Andrea Lukole Jackie Cook Jacklin F Mosha Nancy S Matowo Manisha A Kulkarni Elizabeth Mallya Tatu Aziz Jacklin Martin Mark Rowland Immo Kleinschmidt Alphaxard Manjurano Franklin W Mosha Natacha Protopopoff |
| author_sort | Eliud Andrea Lukole |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-13b4139589874263a7e0d9a1563536a9 |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-01-01 |
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| series | BMC Public Health |
| spelling | doaj-art-13b4139589874263a7e0d9a1563536a92025-02-02T12:46:06ZengBMCBMC Public Health1471-24582025-01-0125111010.1186/s12889-025-21586-xCommunity 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 trialEliud Andrea Lukole0Jackie Cook1Jacklin F Mosha2Nancy S Matowo3Manisha A Kulkarni4Elizabeth Mallya5Tatu Aziz6Jacklin Martin7Mark Rowland8Immo Kleinschmidt9Alphaxard Manjurano10Franklin W Mosha11Natacha Protopopoff12Department of Parasitology, Mwanza Medical Research Centre, National Institute for Medical ResearchMRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical MedicineDepartment of Parasitology, Mwanza Medical Research Centre, National Institute for Medical ResearchDepartment of Disease Control, London School of Hygiene and Tropical MedicineSchool of Epidemiology and Public Health, University of OttawaKilimanjaro Christian Medical University CollegeDepartment of Parasitology, Mwanza Medical Research Centre, National Institute for Medical ResearchKilimanjaro Christian Medical University CollegeDepartment of Disease Control, London School of Hygiene and Tropical MedicineMRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical MedicineDepartment of Parasitology, Mwanza Medical Research Centre, National Institute for Medical ResearchKilimanjaro Christian Medical University CollegeDepartment of Disease Control, London School of Hygiene and Tropical MedicineAbstract 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.https://doi.org/10.1186/s12889-025-21586-xDual active ingredient LLINsCommunity effectMalaria prevalenceTanzania |
| spellingShingle | Eliud Andrea Lukole Jackie Cook Jacklin F Mosha Nancy S Matowo Manisha A Kulkarni Elizabeth Mallya Tatu Aziz Jacklin Martin Mark Rowland Immo Kleinschmidt Alphaxard Manjurano Franklin W Mosha Natacha Protopopoff 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 Dual active ingredient LLINs Community effect Malaria prevalence Tanzania |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Dual active ingredient LLINs Community effect Malaria prevalence Tanzania |
| url | https://doi.org/10.1186/s12889-025-21586-x |
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