Aims: Outdoor malaria transmission is recognized as a major challenge to malaria elimination in the six countries of the Greater Mekong Sub-region (GMS). One possible way to address this might be through the use of insecticide-treated clothing (ITC) as a complementary measure to protect people from mosquito bites before they go to bed and while they are outdoors. This study assessed the wearing practices, durability, and insecticidal effects of ITC among migrant rubber plantation workers in Myanmar.
Methods: Mixed methods were used to assess wearing practices and durability of treated and untreated clothing among rubber tappers in Thanbyuzayat, Mon State, Myanmar.
Results: Acceptability of distributed clothing was high, but reported usage was comparably low at 79.4% (120/151) and mainly attributed to discomfort in the hot dry season. Women (RR: 1.08; p=0.04) and participants with primary education (RR: 1.13; p=0.03) reported higher usage of treated clothing. Women and those with primary, middle or high school level education also reported lower incidence of new holes forming on the treated clothing. Physical damage, frequent washing and outdoor drying limited the extended use of treated clothing. Washed ITC provided some protection against An. baimaii despite relatively high concentrations of permethrin retained in the fabric after one wash.
Conclusion: Behavioural factors and better health awareness may explain the better compliance and condition of clothing (fewer holes) among female and more educated participants. We argue that novel technological approaches to address washout effects, coupled with appropriate behaviour change activities, are needed before ITC is to become a potentially cost-effective and scalable intervention to protect against malaria and Aedes-borne diseases.