Evaluating the impact of eave tubes plus house screening on malaria transmission

INTERVENTION: Villages (clusters) will be allocated to one of two treatments through restricted randomization based on village size and malaria prevalence in children between the ages of 6 months in 10 years. There will be 20 villages in each trial arm with 100‐200 houses per village. Control arm treatment: at the start of the trial, each household will receive the number of long lasting insecticidal nets (LLINs) necessary to achieve universal bed net coverage (1 bed net for ever 2 people in the household. Houses will not be modified in the control arm. Treatment (eave tube) arm treatment: at the start of the trial, each eligible household will be offered the option of having their house modified with eave tubes. This consists of installing eave tubes, screening windows, and sealing any large cracks in the walls. A house is eligible for the intervention if it has a metal roof (as opposed to thatch) and the walls are in sufficiently good condition to support drilling to install the eave tubes. The eave tubes will then be fitted with screened inserts treated with a 10% formulation of beta cyflutherin. After the installation of the eave tubes, each household will also receive LLINs as in the control arm. A subset of study participants in both arms (50 children per village, 2,000 children total) will be enrolled in the epidemiological monitoring, which will involve monthly (November ‐ April) or fortnightly visits (May ‐ October). Every 3 months there will be a "walk through" of all study villages to check the condition of the houses. Participants in the treatment arm will also be informed that they can contact the study team at any point for repairs relating to the eave tube intervention. A sample of insecticide treated inserts will be taken from the treatment villages each month to test for persistence of the insecticide. Inserts will be replaced once post‐exposure mortality in mosquitoes falls below 50% (expected to be every 3‐4 months). CONDITION: Malaria ; Infections and Infestations ; Malaria PRIMARY OUTCOME: Malaria incidence will be monitored in cohorts of children (6 months through 10 years old) through active case detection (ACD) with monthly visits during the dry season (November – April) and fortnightly visits during the rainy reason (May – October). Clinical malaria will be defined as a positive malaria rapid diagnostic test (RDT) and an axillary body temperature of =37.5oC. Malaria infections will be confirmed by PCR of blood samples for malaria parasite DNA. INCLUSION CRITERIA: 1. Aged 6 months – 10 years old 2. Resident in houses enrolled in the study 3. Whose parents/guardians give written, informed consent for their child to be included in the study 4. In the case of school‐aged children, only those who live in their villages throughout the school term will be eligible for enrollment 5. For the results to be as generalizable as possible, no distinctions will be made in terms of medical condition, physical health, gender or ethnic group SECONDARY OUTCOME: 1. Clinical malaria incidence in all children will be measured by clinic visits throughout the course of two year monitoring period. Malaria diagnosis will be defined as any child presenting with an axillary body temperature of =37.5oC and a positive Rapid Diagnostic Test (RDT). ; 2. Prevalence of anemia and respiratory infections in the study cohort, measured twice yearly (April and November) for two years. Anemia will be testing using blood samples and the Hemocue Hb system and defined as moderate (7 – 9.9 g/dL hemoglobin) to severe (<7 g/dL hemoglobin) anemia. Respiratory infections will be diagnosed based on clinical symptoms including coughing, and either a raised age‐specific respiratory rate or chest indrawing. ; 3. Malaria vector densities will be measured by CDC light traps for two nights every month, and by human landing catches for 2 nights every two months. Mosquito species identification will be done based on morphology and confirmed by PCR. Parity rates will be measured through a visual inspection of ovaries and sporozoite prevalence will be measured by ELISA in a subset of the mosquito catches. Prevalence of kdr and ace1 resistance alleles will also be measured through PCR in a subset of the catches.; 4. Data loggers will be used to record hourly temperature and relative humidity in a subset of study houses in each village to determine whether house modifications affect indoor microclimate. A commercial air sampler will be used to assess whether house modifications affect indoor air quality every month from baseline to two years; 5. Public attitudes about malaria, its prevention, and whether eave tube technology is acceptable to the residents will be measured through surveys from baseline to two years