Poster Presentation First Malaria World Congress 2018

Effectiveness of repellent delivered through village health volunteers on malaria incidence in villages in South-East Myanmar: a stepped-wedge cluster-randomised controlled trial (#286)

Paul A Agius 1 2 3 , Julia C Cutts 1 , Win Han Oo 4 5 , Katherine O'Flaherty 1 6 , Naanki Parischa 1 , Kyaw Zayar Aung 4 , Myat Mon Thein 4 , Aung Thi 7 , Htin Kyaw Thu 4 , Aung Paing Soe 4 , James G Beeson 1 8 9 , Brendan Crabb 1 8 9 , Freya JI Fowkes 1 2 6 10
  1. Burnet Institute, Melbourne, Victoria, Australia
  2. Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
  3. Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
  4. Burnet Institute Myanmar, Yangon, Myanmar
  5. School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
  6. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Victoria, Australia
  7. Department of Public Health, Myanmar Ministry of Health and Sports, Nay Pyi Taw, Myanmar
  8. Department of Medicine, the University of Melbourne, Melbourne, Victoria, Australia
  9. Department of Microbiology, Monash University, Melbourne, Victoria, Australia
  10. Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia

Evidence for the effectiveness of repellents distributed to villages through Village Health Volunteers (VHV) in protecting against episodes of malaria is required to inform the implementation of repellents as a component of malaria control and elimination programs in the Greater Mekong Subregion. A 15-month stepped-wedge cluster randomised study including 114 villages in South-east Myanmar was implemented to test the effectiveness of distribution of topical mosquito repellent (N,N-Diethyl benzamide, 12% w/w cream) on Plasmodium spp. infection. Crossed-random effects mixed modelling was undertaken to estimate the effect of repellent distribution on Plasmodium spp. infection detected in 32,194 tests. Non-final analysis showed that, conditional on the effects of time and seasonality, Plasmodium spp. infection diagnosed by rapid diagnostic test and PCR was less likely once villages transitioned into repellent distribution. There was significant heterogeneity observed in the nature of the effect of repellent distribution between villages and we observed a greater level of heterogeneity in Plasmodium spp. infection between villages than across cross-sectional testing occasions. We observed a significant decline in Plasmodium spp. infection across the study period, independent of the intervention and seasonal variations in incidence most likely due to the increased access to malaria services provided by the VHV. Malaria services, including provision of personal protection such as repellent, provided by VHV may contribute to significant reductions in malaria.