Humanitarian Evaluation of Spatial Emanators for Malaria Control

The overall aim of this study is to evaluate the feasibility, implementation, public health effectiveness, durability, acceptability and cost of delivering long-lasting spatial emanators at scale through United Nations High Commissioner for Refugees (UNHCR) humanitarian supply chains and distribution systems in northern South Sudan. Primary objective: To determine whether distribution of Guardian™ long-lasting spatial emanators reduces all-age malaria infection prevalence at 6 months in intervention populations compared with contemporaneous control populations during Phase 1 of the study. Secondary objectives: * Estimate the effect of Guardian™ on indoor and outdoor mosquito biting rate, including female Anopheles landing rates. * Evaluate the feasibility and fidelity of humanitarian delivery through UNHCR supply chains, including timeliness, household coverage, adequacy of units relative to shelter volume, unpacking, correct placement and retention. * Assess acceptability and safety, including user understanding, perceived benefit, barriers to use, product-related concerns and willingness to continue use or receive replacement units. * Assess product durability and performance through field observations of physical integrity and quantitative chemical analysis of retrieved units. * Describe changes in routine health facility malaria indicators and household-reported febrile illness as complementary measures of public health impact. Tertiary and exploratory objectives: * Estimate the cost and cost-efficiency of humanitarian delivery, including cost per unit delivered, household reached, person protected and correctly protected person-month, and estimate cost-effectiveness where supported by effectiveness data. * Examine whether coverage, dose adequacy, correct placement, retention, shelter characteristics, population movement, seasonality and other contextual factors explain heterogeneity in epidemiological or entomological effects. * Compare implementation performance and acceptability across different beneficiary groups (refugee camps, host communities and newly arriving displaced populations). * Integrate epidemiological, entomological, implementation, qualitative, durability and economic findings to inform transition of long-lasting spatial emanators toward routine use as a humanitarian vector control commodity and guide future UNHCR, Ministry of Health and WHO implementation and scale-up decisions.