A new tool for malaria prevention?: Results of a trial of permethrin-impregnated bedsheets (shukas) in an area of unstable transmission

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Abstract
Background Despite gains in malaria control through impregnated treated nets (ITN), malaria remains a major concern. Netting is expensive and impractical for many communities. Here we present the findings of a community-based trial of impregnated bedsheets (shukas) in Kenya. Methods A total of 472 individuals were enrolled in a randomized community trial where the unit of randomization was the hamlet (manyatta). Baseline data included socio-demographic data, parasite prevalence data from thick and thin blood smears, and clinical measures of malaria. The intervention involved the dipping of shukas owned by the experimental group in permethrin. Findings The prevalence of malaria in the study population (based on laboratory results) was considerably lower than that used for the power calculation based on clinical estimates (2.2% versus 20%). For those aged 6 or over, the rate of malaria cases (events per 10 000 person-days at risk) was 1.41 in the experimental group versus 7.49 in the control group (incidence rate ratio 0.187, 95% CI: 0.046– 0.770). For children ≤5 years of age results were imprecise with no clear benefit of the intervention. Conclusions These results suggest that permethrin-impregnated bedsheets may be protective against malaria prevention but further studies with greater power are required to confirm this.