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Evaluation of the effectiveness of topical repellent distributed by village health volunteer networks against Plasmodium spp. infection in Myanmar: A stepped-wedge cluster randomised trial

Agius, PA, Cutts, JC, Oo, WH, Thi, A, O’Flaherty, K, Aung, KZ, Thu, HK, Aung, PP, Thein, MM, Zaw, NN, Min Htay, WY, Soe, AP, Razook, Z, Barry, Alyssa, Htike, W, Devine, A, Simpson, JA, Crabb, BS, Beeson, JG, Pasricha, N and Fowkes, FJI 2020, Evaluation of the effectiveness of topical repellent distributed by village health volunteer networks against Plasmodium spp. infection in Myanmar: A stepped-wedge cluster randomised trial, PLoS Medicine, vol. 17, no. 8, pp. 1-21, doi: 10.1371/journal.pmed.1003177.

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Title Evaluation of the effectiveness of topical repellent distributed by village health volunteer networks against Plasmodium spp. infection in Myanmar: A stepped-wedge cluster randomised trial
Author(s) Agius, PA
Cutts, JC
Oo, WH
Thi, A
O’Flaherty, K
Aung, KZ
Thu, HK
Aung, PP
Thein, MM
Zaw, NN
Min Htay, WY
Soe, AP
Razook, Z
Barry, AlyssaORCID iD for Barry, Alyssa orcid.org/0000-0002-1189-2310
Htike, W
Devine, A
Simpson, JA
Crabb, BS
Beeson, JG
Pasricha, N
Fowkes, FJI
Journal name PLoS Medicine
Volume number 17
Issue number 8
Start page 1
End page 21
Total pages 21
Publisher PLOS
Place of publication San Francisco, CA
Publication date 2020-08-20
ISSN 1549-1277
1549-1676
Keyword(s) Malaria
Plasmodium
Polymerase chain reaction
Medical risk factors
Plasmodium falciparum
Statistical distributions
Public and occupational health
Diagnostic medicine
Summary Background: The World Health Organization has yet to endorse deployment of topical repellents for malaria prevention as part of public health campaigns. We aimed to quantify the effectiveness of repellent distributed by the village health volunteer (VHV) network in the Greater Mekong Subregion (GMS) in reducing malaria in order to advance regional malaria elimination. Methods and findings: Between April 2015 and June 2016, a 15-month stepped-wedge cluster randomised trial was conducted in 116 villages in Myanmar (stepped monthly in blocks) to test the effectiveness of 12% N,N-diethylbenzamide w/w cream distributed by VHVs, on Plasmodium spp. infection. The median age of participants was 18 years, approximately half were female, and the majority were either village residents (46%) or forest dwellers (40%). No adverse events were reported during the study. Generalised linear mixed modelling estimated the effect of repellent on infection detected by rapid diagnostic test (RDT) (primary outcome) and polymerase chain reaction (PCR) (secondary outcome). Overall Plasmodium infection detected by RDT was low (0.16%; 50/32,194), but infection detected by PCR was higher (3%; 419/13,157). There was no significant protection against RDT-detectable infection (adjusted odds ratio [AOR] = 0.25, 95% CI 0.004–15.2, p = 0.512). In Plasmodium-species-specific analyses, repellent protected against PCR-detectable P. falciparum (adjusted relative risk ratio [ARRR] = 0.67, 95% CI 0.47–0.95, p = 0.026), but not P. vivax infection (ARRR = 1.41, 95% CI 0.80–2.47, p = 0.233). Repellent effects were similar when delayed effects were modelled, across risk groups, and regardless of village-level and temporal heterogeneity in malaria prevalence. The incremental cost-effectiveness ratio was US$256 per PCR-detectable infection averted. Study limitations were a lower than expected Plasmodium spp. infection rate and potential geographic dilution of the intervention. Conclusions: In this study, we observed apparent protection against new infections associated with the large-scale distribution of repellent by VHVs. Incorporation of repellent into national strategies, particularly in areas where bed nets are less effective, may contribute to the interruption of malaria transmission. Further studies are warranted across different transmission settings and populations, from the GMS and beyond, to inform WHO public health policy on the deployment of topical repellents for malaria prevention.
Language eng
DOI 10.1371/journal.pmed.1003177
Indigenous content off
Field of Research 11 Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2020, Agius et al.
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30141021

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.