Abstract:
BACKGROUND : Malaria prevention in Africa is mainly through the use of long-lasting insecticide treated nets (LLINs).
The objective of the study was to assess the effect of supplementing LLINs with either larviciding with Bacillus thuringiensis
israelensis (Bti) or community education and mobilization (CEM), or with both interventions in the context of
integrated vector management (IVM).
METHODS : The study involved a factorial, cluster-randomized, controlled trial conducted in Malindi and Nyabondo
sites in Kenya and Tolay site in Ethiopia, to assess the impact of the following four intervention options on mosquitoes
and malaria prevalence: LLINs only (arm 1); LLINs and Bti (arm 2); LLINs and CEM (arm 3); and, LLINs combined with Bti
and CEM (arm 4). Between January 2013 and December 2015, CDC light traps were used to sample adult mosquitoes
during the second, third and fourth quarter of each year in 10 houses in each of 16 villages at each of the three study
sites. Larvae were sampled once a fortnight from potential mosquito-breeding habitats using standard plastic dippers.
Cross-sectional malaria parasite prevalence surveys were conducted involving a total of 11,846 primary school children
during the 3-year period, including 4800 children in Tolay, 3000 in Malindi and 4046 in Nyabondo study sites.
RESULTS : Baseline relative indoor anopheline density was 0.11, 0.05 and 0.02 mosquitoes per house per night in
Malindi, Tolay and Nyabondo sites, respectively. Nyabondo had the highest recorded overall average malaria prevalence
among school children at 32.4%, followed by Malindi with 5.7% and Tolay 1.7%. There was no significant reduction
in adult anopheline density at each of the three sites, which could be attributed to adding of the supplementary
interventions to the usage of LLINs. Malaria prevalence was significantly reduced by 50% in Tolay when using LLINs
coupled with application of Bti, community education and mobilization. The two other sites did not reveal significant
reduction of prevalence as a result of combining LLINs with any of the other supplementary interventions.
CONCLUSION : Combining LLINs with larviciding with Bti and CEM further reduced malaria infection in a low prevalence
setting in Ethiopia, but not at sites with relatively higher prevalence in Kenya. More research is necessary at the selected sites in Kenya to periodically determine the suite of vector control interventions and broader disease
management strategies, which when integrated would further reduce adult anopheline populations and malaria
prevalence beyond what is achieved with LLINs.
