Permethrin-treated baby wraps for the prevention of malaria: results of a randomized controlled pilot study in rural Uganda

Abstract

Background Progress against malaria has stalled and may even be slipping backwards in high-burden countries. This is due to a range of factors including insecticide resistance and mosquito feeding behaviours that limit contact with widely-employed interventions including long-lasting insecticidal nets and indoor-residual spraying. Thus, further innovations in malaria control are urgently needed. Methods The pilot was a randomized, placebo-controlled pilot study of permethrin-treated baby wraps—known locally as lesus—in children 6–18 months of age at a single site in rural western Uganda. Fifty mother–infant pairs were assigned to permethrin-treated or untreated lesus in a 1:1 allocation. Participants and clinical staff were blinded to group assignments through use of sham treatment and re-treatment of lesus. Participants attended scheduled clinic visits every 2 weeks for a total 12 weeks. The primary outcome of interest was the safety of the intervention, assessed as changes in the frequency of use, rates of discontinuation, and incidence of adverse events, such as skin rash. Secondary outcomes included acceptability and feasibility of the intervention as measured through participant satisfaction and completion of study activities, respectively. Results Overall, rates of retention and participation were relatively high with 86.0% (43 of 50) of participants completing all scheduled visits, including 18 (75.0%) and 25 (96.2%) in the intervention and control arms respectively. By the conclusion of the 12-week follow-up period, one adverse event (0.35 events per 100 person-weeks, one-sided 95% CI 0.0–1.65) was reported. Satisfaction with the lesu was high in both groups. In each study arm, there were five incident RDT positive results, but the only PCR-positive results were observed in the control group (n = 2). Conclusions Permethrin-treated baby wraps were well-tolerated and broadly acceptable. Adverse events were infrequent and mild. These findings support future trials seeking to determine the efficacy of treated wraps to prevent P. falciparum malaria infection in young children as a complementary tool to existing household-based interventions. Trial registration: ClinicalTrials.gov Identifier: NCT04102592, Registered 25 September 2019. Available at: https://clinicaltrials.gov/ct2/show/NCT04102592

The Association between Malnutrition and Malaria Infection in Children under 5 Years in Burkina Faso: A Longitudinal Study

“…Previous studies suggest that mechanisms by which malnutrition could protect against malaria infection include improved ability of malnourished children to produce certain cytokines in response to stimulation by specific malarial antigens 29 and potential confounding resulting from improved malaria preventive measures for ill children, 15 as malnutrition can be accompanied by other illnesses. In particular, because newborns and infants are usually wrapped with clothing and carried on the back of the mother or caregiver in most African countries, 30 they may have had additional protection from exposure to mosquitoes. One study explored how to use this practice by treating clothing for added protection from malaria.…”

“…One study explored how to use this practice by treating clothing for added protection from malaria. 30 Therefore, infants in general and those with illnesses and weaker immunity, in particular, may be kept closer physically and cared for differently.…”

Permethrin-treated baby wraps for the prevention of malaria in children: Protocol for a double-blind, randomized placebo-controlled controlled trial in western Uganda

“…Given the high level of subject participation and retention in the pilot study [ 34 ], we expect most mother-infant pairs to complete all study activities. Missing data due to dropout or missed clinic visits are anticipated to be uncommon (≤5% missing), so a complete case analysis is planned.…”

“…falciparum malaria in children 6–24 months of age in western Uganda. This trial builds on the work of a pilot feasibility study conducted in 2019, the results of which indicated that permethrin-treated baby wraps were well-tolerated and broadly acceptable, while adverse events were infrequent and mild [ 34 ]. These findings support the need for larger trials to evaluate the efficacy of the permethrin-treated lesus .…”

Um modelo de programação linear inteira mista para a alocação de funcionários de uma empresa de software

“…Como exemplos destes trabalhos se pode citar (ALSERKAL et al, 2020), (LINNAN et al, 2020), (SHIMA et al, 2021) e (BOYCE et al, 2022.…”