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• W2197093224 abstract "Background: Current malaria control tools, long lasting insecticidal nets and indoorresidual spraying have had a significant impact on malaria transmission in sub-SaharanAfrica. However these tools will not be able to eradicate malaria and there is need forcomplementary tools if this goal is to be attained. This work focused on evaluating andrecommending tools that can be used to complement current control tools with emphasis onoutdoor and early evening transmission. The main tool evaluated in this thesis was a topicalrepellent to be used in the early evening. Other tools recommended were spatial repellentsand permethrin- impregnated clothing.Methods: A repellent efficacy trial was conducted in the semi-field and field setting toevaluate the protection from early evening biting given by a topical repellent lotioncontaining 15% N.N-diethyl-m-toluamide (DEET). A cluster randomized, placebo controlledclinical trial, designed to assess the effect of 15% DEET against malaria transmitted in theearly evening was then conducted in a village in rural Tanzania. A total of 940 householdswere recruited and randomized, with 462 households randomized to the intervention arm and462 households randomized to the control arm. The feasibility of lotion repellent use wasassessed using entry and exit questionnaires. Focus group discussions were conducted 3 yearsafter a clinical trial to assess the community knowledge, attitude and practice towards adifferent set of repellents to those used during the clinical trial. A systematic review was thenconducted to put the results of this trial in context with other repellent trials. An attempt wasmade to design a clinical trial taking into account the shortcomings of the current and otherrepellent trials reviewed. Findings: Topical repellents containing 15% DEET provided >80% protection againstearly evening biting over four hours. According to protocol analysis of the clusterrandomized trial found no difference between the intervention and control arms afteraccounting for socio-economic status, education of household head and householdconstruction materials (Wilcoxon rank sum z = 0.529, p = 0.596). The most importantpredictor of malaria in this study was age, with younger age categories significantlyassociated with greater malaria risk. Socio-economic status was not associated with malaria.Compliance to repellent use was reported to be 80% during the study. From the FGDs, itemerged that community knowledge was the major barrier to repellent use, followed closelywith availability. The community preferred using long lasting insecticidal nets (LLINs)because of their cost effectiveness. However, the community preferred using repellents in theearly evening before employing LLINs.Interpretation: This study demonstrates that topical repellents have no effect againstearly evening malaria transmission in this community. However, shortcomings in the designand implementation might have masked the treatment effect and better-designed studies arerequired to establish repellents effect in this setting. Topical repellents provided protectionagainst early evening biting and were readily accepted and used in this community, indicatingthe potential of using repellents complimentary to LLINs in this setting. The short-termduration of effect of this repellent, required frequent reapplication and therefore impactedcompliance, emphasizing that future studies should consider using longer lasting tools suchas spatial repellents." @default.
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• W2197093224 date "2015-10-05" @default.
• W2197093224 modified "2023-09-27" @default.
• W2197093224 title "Can repellents prevent malaria in Tanzania" @default.
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• W2197093224 doi "https://doi.org/10.17037/pubs.02374474" @default.
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