Comparative evaluation of standard and dual-treated insecticide bednets in Sud Ubangi, Democratic Republic of Congo

INTERVENTION: A total of 16 clusters (provincial health zones) are involved in the study; clusters were randomised to receive a different type of treated bednet by a member of LSTM staff, who will not be directly involved in the study. All houses within the eight zones allocated to group 1 will receive standard (pyrethroid only) bednet; within the seven zones allocated to group 2 will receive a PBO co‐treated bednet. Within the remaining zone, the distribution will be mixed with one part receiving each bednet, as dictated by different numbers of bednets available within the distribution programme. Bednets, supplied by Against Malaria Foundation, will be distributed in Sud Ubangi by IMA World Health in partnership with SANRU (DRC rural health programme). All households in Sud Ubangi will receive sufficient nets to permit coverage of one net per two occupants. At the time of distribution, nets will be hung over sleeping spaces by the distribution team partners with an accompanying education programme to increase correct usage, care and maintenance of nets by householders. The study team have no role in the distribution or hanging of bednets or the bednet‐related education programme. The study involves: 1. Determination of parasite prevalence in women visiting monthly antenatal clinics 2. Entomological collections for surveillance of insecticide resistance and mosquito abundance and parasite infection 3. Assessment of bednet durability (physical and chemical analysis) and bioefficacy (against mosquitoes) over time The intervention is not under control of the trial but it is planned by the Ministry of Health to replace the nets after a minimum of 36 months, which could be viewed as the end of the intervention. The follow up is planned to be 36 months, subject to continuation of funding (guaranteed for 12 months as present from start of the trial period). CONDITION: Malaria ; Infections and Infestations ; Unspecified malaria PRIMARY OUTCOME: Parasite prevalence (defined as the proportion of positive malaria rapid diagnostic tests) in pregnant women assessed at 0, 6 months, 12 months, 18 months, 24 months, 30 months, 36 months after bednet distribution INCLUSION CRITERIA: Women attending first ANC appointment at a clinic that is taking part in the study and who consent to be enrolled in the study SECONDARY OUTCOME: ; 1. Frequency of molecular markers associated with insecticide resistance in the primary malaria vector mosquito (Anopheles gambiae) is measured from DNA extracted from mosquitoes collected in one half of the study clusters at 0, 6 months, 12 months, 18 months, 24 months, 30 months, 36 months after bednet distribution; 2. Mosquito abundance and parasite infection rate (with the infectious sporozoite stage) will be measured in one half of the study clusters at 0, 6 months, 12 months, 18 months, 24 months, 30 months, 36 months after bednet distribution; 3. Prevalence and intensity of phenotypic insecticide resistance, assessed using World Health Organization (WHO) tests of insecticide, in 4 study clusters at 0, 6 months, 12 months, 18 months, 24 months, 30 months, 36 months after bednet distribution; 4. Bednet durability and bio‐efficacy assessed will be measured using WHO guidelines for physical assessment of the area of holes, chemical analysis of insecticide (and PBO) concentrations and capacity of the net material to kill locally‐caught mosquitoes in controlled experiments in nets collected from 4 study clusters at 0, 6 months, 12 months, 18 months, 24 months, 30 months, 36 months after bednet distribution;