An observational study evaluating the epidemiological and entomological impacts of piperonyl butoxide insecticide-treated nets (ITNs) compared to a combination of indoor residual spraying (IRS) plus standard pyrethroid-only ITNs in Amhara Region, Ethiopia, 2019-2023.
Kelly M Davis, Amha Worku, Meshesha Balkew, Peter Mumba, Sheleme Chibsa, Jon Eric Tongren, Gudissa Assefa, Achamyelesh Sisay, Dawit Teshome, Banchamlak Tegegne, Mastewal Worku, Mulat Yimer, Delenasaw Yewhalaw, Melissa Yoshimizu, Sarah Zohdy, Isabel Swamidoss, Carla Mapp, Jimee Hwang, Wendy Inouye, Aklilu Seyoum, Cecilia Flatley, Emily R Hilton, Dereje Dengela, Sarah M Burnett
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引用次数: 0
Abstract
Introduction: National malaria programmes must weigh the relative benefits of different vector control and elimination tools to prioritise resource allocation with the greatest impact. This study assesses the epidemiological and entomological impacts of piperonyl butoxide insecticide-treated nets (PBO ITN-only arm) compared with the combination of two annual non-pyrethroid indoor residual spraying (IRS) campaigns and standard pyrethroid ITNs (IRS+Standard Pyrethroid ITN arm) in the Amhara region of Ethiopia.
Methods: An open-label, stratified block-cluster randomised trial was designed to compare the impacts of the two intervention arms. ITN distribution took place from June to July 2021. IRS campaigns took place from June to July 2021 and again in June 2022. Confirmed malaria cases reported during the high transmission season (September to December) were compared in the 2 years before (2019 and 2020) vs the 2 years after (2021 and 2022) the 2021 campaigns. The difference in An. gambiae s.l. vector density per trap and indoor resting density (IRD) was assessed between the two arms during the high transmission seasons 2 years after the 2021 campaigns.
Results: Estimated malaria cases decreased significantly by 53.6% in the postintervention period compared with preintervention in the IRS+Standard Pyrethroid ITN arm (95% CI -72.9%, -29.8%) and by 55.9% in the PBO ITN arm (95% CI -73.0%, -32.5%), with no significant difference between these two arms (95% CI -30.9%, 24.0%). From the first to the second season postintervention, cases decreased non-significantly in the IRS+Standard Pyrethroid ITN arm (incidence rate ratio (IRR) 0.94; 95% CI 0.66, 1.47) but increased significantly in the PBO ITN arm (IRR 1.98; 95% CI 1.49, 2.67). Postintervention vector density and IRD were not found to be significantly different between intervention arms in either 2021 (vector density: IRR 0.78; 95% CI 0.47, 1.31; IRD: IRR 0.80; 95% CI 0.37, 1.75) or 2022 (vector density: IRR 1.27; 95% CI 0.75, 2.12; IRD: IRR 1.02; 95% CI 0.45, 2.28).
Conclusion: These findings suggest a positive impact of non-pyrethroid IRS deployed annually alongside standard pyrethroid ITNs in a setting of confirmed pyrethroid resistance. While an overall positive impact of PBO ITNs was detected, a waning impact of the nets 2 years postdistribution was observed.
导言：国家疟疾规划必须权衡不同病媒控制和消除工具的相对效益，以便优先分配具有最大影响的资源。本研究评估了在埃塞俄比亚阿姆哈拉地区使用胡椒酰丁醇驱虫蚊帐（PBO单杀虫剂组）与两次年度非拟除虫菊酯室内残留喷洒（IRS）和标准拟除虫菊酯驱虫蚊帐（IRS+标准拟除虫菊酯驱虫蚊帐组）联合使用的流行病学和昆虫学影响。方法：设计一项开放标签、分层块群随机试验，比较两个干预组的影响。ITN分发于2021年6月至7月进行。国税局的竞选活动于2021年6月至7月举行，并于2022年6月再次举行。将2021年运动前两年（2019年和2020年）与2021年运动后两年（2021年和2022年）在高传播季节（9月至12月）报告的确诊疟疾病例进行比较。An的区别。在2021年运动后2年的高传播季节期间，评估了每个陷阱的冈比亚线虫病媒密度和室内静息密度（IRD）。结果：与干预前相比，干预后IRS+标准拟除虫菊酯ITN组估计疟疾病例显著减少53.6% (95% CI -72.9%, -29.8%)， PBO ITN组估计疟疾病例显著减少55.9% (95% CI -73.0%, -32.5%)，两组间无显著差异（95% CI -30.9%, 24.0%）。干预后第一季至第二季，IRS+标准拟除虫菊酯ITN组病例数无显著下降(发病率比（IRR） 0.94；95% CI 0.66, 1.47)，但在PBO ITN组显著增加(IRR 1.98；95% ci 1.49, 2.67)。2021年干预后的病媒密度和IRD在干预组间均无显著差异(病媒密度：IRR 0.78；95% ci 0.47, 1.31；irr: 0.80；95% CI 0.37, 1.75)或2022(媒介密度：IRR 1.27；95% ci 0.75, 2.12；irr: 1.02；95% ci 0.45, 2.28)。结论：这些发现表明，在已确认的拟除虫菊酯类杀虫剂抗药性情况下，每年与标准拟除虫菊酯类杀虫剂杀虫剂一起部署非拟除虫菊酯类杀虫剂杀虫剂具有积极影响。虽然发现了PBO ITNs的总体积极影响，但观察到网在分配后2年的影响逐渐减弱。
期刊介绍：
BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.
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