Laboratory of Entomology, Wageningen University and Research Centre, Wageningen, Netherlands.
International Centre of Insect Physiology and Ecology, Nairobi, Kenya.
Lancet. 2016 Sep 17;388(10050):1193-201. doi: 10.1016/S0140-6736(16)30445-7. Epub 2016 Aug 9.
Odour baits can attract host-seeking Anopheles mosquitoes indoors and outdoors. We assessed the effects of mass deployment of odour-baited traps on malaria transmission and disease burden.
We installed solar-powered odour-baited mosquito trapping systems (SMoTS) to households on Rusinga Island, Lake Victoria, western Kenya (mean population 24 879), in a stepped-wedge cluster-randomised trial. All residents in the completed health and demographic surveillance system were eligible to participate. We used the travelling salesman algorithm to assign all households to a cluster (50 or 51 geographically contiguous households); nine contiguous clusters formed a metacluster. Initially, no cluster had SMoTS (non-intervened). During the course of the intervention roll-out SMoTS were gradually installed cluster by cluster until all clusters had SMoTS installed (intervened). We generated 27 cluster randomisations, with the cluster as unit of randomisation, to establish the order to install the traps in the clusters until all had a SMoTS installed. Field workers and participants were not masked to group allocation. The primary outcome of clinical malaria was monitored through repeated household visits covering the entire population, once before roll-out (baseline) and five times throughout the 2-year roll-out. We measured clinical malaria as fever plus a positive result with a rapid diagnostic test. The SolarMal project was registered on the Dutch Trial Register (NTR 3496).
We enrolled 34 041 participants between April 25, 2012, and March 23, 2015, to 81 clusters and nine metaclusters. 4358 households were provided with SMoTS during roll-out between June 3, 2013, and May 16, 2015. 23 clinical malaria episodes were recorded in intervened clusters and 33 episodes in non-intervened clusters (adjusted effectiveness 40·8% [95% CI -172·8 to 87·1], p=0·5) during the roll-out. Malaria prevalence measured by rapid diagnostic test was 29·8% (95% CI 20·9-38·0) lower in SMoTS clusters (prevalence 23·7%; 1552 of 6550 people) than in non-intervened clusters (prevalence 34·5%; 2002 of 5795 people).
The unexpectedly low clinical incidence of malaria during roll-out led to an imprecise estimate of effectiveness from the clinical incidence data. The substantial effect on malaria prevalence is explained by reduction in densities of Anopheles funestus. Odour-baited traps might be an effective malaria intervention.
COmON Foundation.
气味诱饵可以吸引室内外寻找宿主的疟蚊。我们评估了大规模部署气味诱捕器对疟疾传播和疾病负担的影响。
我们在肯尼亚维多利亚湖鲁辛加岛（平均人口 24879 人）的家庭中安装了太阳能驱动的气味诱捕蚊系统（SMoTS），这是一项基于 stepped-wedge 集群随机对照试验。所有完成健康和人口监测系统的居民都有资格参加。我们使用旅行商算法将所有家庭分配到一个集群（50 或 51 个地理上相邻的家庭）；九个相邻的集群组成一个超集群。最初，没有集群有 SMoTS（未干预）。在干预实施过程中，SMoTS 逐渐逐群安装，直到所有集群都安装了 SMoTS（干预）。我们生成了 27 个集群随机化，以集群为单位进行随机化，以确定在集群中安装诱捕器的顺序，直到所有集群都安装了诱捕器。现场工作人员和参与者对分组分配没有进行掩盖。通过对整个人群进行反复家访来监测临床疟疾的主要结局，在实施前（基线）进行一次，在实施的 2 年期间进行五次。我们将临床疟疾定义为发热加快速诊断测试阳性。SolarMal 项目已在荷兰试验登记处（NTR 3496）注册。
我们于 2012 年 4 月 25 日至 2015 年 3 月 23 日期间将 34041 名参与者纳入 81 个集群和 9 个超集群。在 2013 年 6 月 3 日至 2015 年 5 月 16 日期间，有 4358 户家庭在实施过程中获得了 SMoTS。在实施期间，干预集群记录了 23 例临床疟疾病例，而非干预集群记录了 33 例（调整有效性 40.8%[-172.8 至 87.1]，p=0.5）。快速诊断检测法测量的疟疾患病率在 SMoTS 集群中降低了 29.8%（95%CI 20.9-38.0）（患病率 23.7%；6550 人中 1552 人），而非干预集群中降低了 34.5%（患病率 34.5%；5795 人中 2002 人）。
实施过程中疟疾临床发病率出乎意料地低，导致从临床发病率数据中得出的有效性估计不精确。疟疾患病率的显著下降是由冈比亚按蚊密度的降低所解释的。气味诱捕器可能是一种有效的疟疾干预措施。
COmON 基金会。
Zotero 插件