Chapel Hill, N.C. — A clinical trial designed to expand malaria protection for young children, led by Ross Boyce, MD, MSc, with the UNC Institute for Global Health and Infectious Diseases at the UNC School of Medicine, has been awarded $5.9 million from the National Institutes of Health. Co-investigators include Jon Juliano, MD, MSPH, Raquel Reyes, MD, MPH, and Bonnie Shook-Sa, DrPH.
Malaria remains one of the world’s most pressing global health challenges, responsible for approximately 600,000 deaths annually, with the overwhelming majority occurring among young children in sub-Saharan Africa. Despite decades of progress, recent gains have stalled due to insecticide resistance and changing mosquito behaviors, underscoring the urgent need for new, complementary prevention strategies.
The NIH-funded project will build on pioneering work led by Dr. Ross Boyce and partners at Mbarara University of Science and Technology (MUST) in Uganda. A previous clinical trial, published in the New England Journal of Medicine, demonstrated that permethrin-treated baby wraps reduced malaria incidence by approximately 66% compared with untreated wraps, even when children were provided with new insecticide-treated bed nets.
“Our earlier trial showed treated wraps can significantly reduce malaria infections, above and beyond existing interventions. This next phase allows us to test whether a long-lasting version – one that doesn’t require re-treatment – can deliver that same protection at larger scale and over a longer time period,” said Dr. Ross Boyce, associate professor of medicine and epidemiology.
“By building on everyday caregiving practices, we have an opportunity to achieve protection against malaria during the times when young children are not protected by nets.”
A Culturally Integrated Solution
Across many regions of sub-Saharan Africa, mothers carry young children using cloth wraps—known as lesu in Uganda—throughout infancy and early childhood. Treating these widely used wraps with a repellent, creates a protective barrier against mosquito bites during periods when children are not shielded by bed nets, such as during outdoor activity or early evening hours.
The new NIH-supported study will test factory-treated, long-lasting wraps designed to retain protective effects for extended periods without the need for frequent retreatment—an important step toward scalable implementation.
A Large-Scale Clinical Trial in Uganda
The project will enroll 750 mother-infant pairs across three regions of Uganda with varying levels of malaria transmission. Participants will be followed for up to three years to evaluate the real-world effectiveness and safety of the intervention in combination with existing tools such as insecticide-treated bed nets and malaria vaccines.
“This study represents the next critical step in translating a highly effective intervention into something that can be delivered at scale,” said Dr. Edgar Mulogo, co-principal investigator at MUST. “Our long-standing collaboration with UNC allows us to pair local expertise with global research capacity to address one of Uganda’s most urgent public health challenges.”
The study will also assess potential impacts on child growth and neurodevelopment, ensuring a comprehensive understanding of the balance of long-term safety concerns compared to the potential benefits of a reduction in malaria early in child’s life. With partners from North Carolina State University, the study will also investigate how mosquitoes interact with the wraps, particularly after extended periods of use.
Potential for Transformational Impact
Factory-treated wraps provide a low-cost, scalable, and culturally aligned intervention that complements existing malaria prevention tools. This strategy targets critical gaps—particularly protection against outdoor and early evening mosquito exposure—while leveraging practices already familiar to families.
Researchers believe this innovation could not only reduce disease burden but also help sustain progress in the face of evolving challenges such as insecticide resistance and constraints in vaccine delivery systems.