Published today in the New England Journal of Medicine, this trial led by Ross Boyce, MD, MSc and colleagues highlights the potential impact of permethrin-treated textiles as a novel tool in the fight against malaria.
Malaria remains a major cause of childhood mortality in sub-Saharan Africa, responsible for nearly 600,000 deaths in 2023 alone–almost of which occurred in children under five years of age. The introduction of bed nets and better treatments reduced the burden of malaria, but global progress has stalled. One cause may be increased mosquito biting outside the home as mosquitoes have adopted to avoid nets and indoor spraying.
In much of Africa, mothers carry young children on their backs in a wrap known locally as a lesu. It can also serve as a blanket when children are set down or put to bed. Dr. Ross Boyce–a researcher with the Institute for Global Health and Infectious Diseases in collaboration with Edgar Mulogo, PhD, MPH, at Mbarara University of Science and Technology in Uganda–hypothesized that treating wraps with repellent would provide an additional layer of protection against malaria.
Study Design
Between June 2022 and April 2024, the study recruited mother-infant pairs in partnership with local community health workers in western Uganda. Half of the participants (200) received wraps that had been treated with permethrin, while the other half (200) received untreated wraps. Wraps were then retreated every month to prevent washout with use. All participants also received a new mosquito net to ensure that the study was testing the effect of the wrap above and beyond existing interventions.
Participants attended follow up visits at the study clinics every two weeks for 6 months. If a child developed a fever in between visits they returned to the clinic and were tested for malaria. If positive, children were treated with an antimalarial medication. The study team maintained a record of the number of malaria cases in among those with treated and untreated wraps. At the final visit, participants were interviewed about their experience.
Findings
In total, there were 94 (73.4%) malaria infections occurring in the untreated wrap group and 34 (26.6%) in the permethrin-treated arm, a reduction of approximately 65% over the study period. In addition, there were fewer malaria-related hospitalizations (10 vs 20) in the permethrin-treated as compared to untreated arm, although there weren’t enough hospitalizations to confirm this effect. Importantly, there were no serious adverse events and few side effects from wrap use.
Next Steps
Boyce says there is a need to investigate factory-treatment of the wraps, which would eliminate the need for monthly re-treatment.
“The technology to do this already exists with a single treatment that has been shown to remain effective for up to a year.” Doing so, Boyce believes, will make wraps much easier to implement in routine use.
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