Insecticide treated eave nets and window screens for malaria control

长效驱虫蚊帐是疟疾控制的一个关键组成部分，可以挽救许多生命;但它们也有一些缺点。生活在疟疾流行地区的人中约有一半得不到长效驱虫蚊帐。造成这种短缺的部分原因是蚊帐供应不足，但一个主要因素是长效蚊帐很快遭到损坏，导致蚊帐的使用寿命少于预期的3年。此外，家庭中的某些群体通常无法平等地获得蚊帐。例如，虽然最年幼的儿童及其母亲可能睡在蚊帐里，但学龄儿童往往很难获得蚊帐。即使是那些有机会获得蚊帐的人，也只有在睡觉时才能得到保护。我们提出了一种新的工具-- ITEN是专门制作的网卷，由当地团队使用锤子和钉子在30分钟内将其应用于屋顶悬垂下的房屋和窗户。与长效驱虫蚊帐相比，这些干预措施至少有三个潜在优势：保护家庭中的每个人;在家庭中的任何时候都能保护他们;可能比长效驱虫蚊帐更持久，最多可提供5年的保护，成本效益高（每户每年比长效驱虫蚊帐少1.75美元）。在住户结构的屋檐上安装的驱虫蚊帐和窗户上的驱虫蚊帐在按蚊进入房屋的主要入口处阻止和杀死按蚊。蚊子被吸引到房子里，试图通过屋檐或窗户进入，并在干预措施中遇到杀虫剂，将房子变成一个“引诱和杀死”，不仅保护房子里的人，而且保护社区中的每个人。2012- 2014年，在肯尼亚西部的80个家庭中对ITEN和ITWS进行了初步的家庭随机评估，结果显示，与仅使用长效驱虫蚊帐的家庭相比，使用ITEN、ITWS和长效驱虫蚊帐的家庭中的病媒蚊子减少了75%。ITEN和ITWS已经可以使用，并且可以扩展，可以安装在任何类型的房屋上，在使用杀虫剂方面，ITEN和ITWS比长效驱虫蚊帐有优势。长效杀虫剂每天都要接触，并定期清洗，限制了可以使用的化学品范围。ITEN和ITWS与更广泛的杀虫剂兼容。这将是非常有利的，因为在非洲，由于蚊子的抗药性越来越强，用于疟疾控制的杀虫剂越来越不有效，特别是因为抗药性是一种地方现象：在一个地方有效的化学品可能在另一个地方无效，因此有广泛的杀虫剂选择至关重要。此外，ITEN和ITWS可以由更致密、更耐用的材料制成。这不仅使它们在物理上更耐用，而且可以浸渍更大量的杀虫剂，杀死更多的蚊子，甚至是抗药性蚊子，并使效果持续更长时间。我们建议在适当的时候在坦桑尼亚进行一项大规模的流行病学终点的集群随机试验。然而，在此之前，有必要研究哪种杀虫剂的特定组合适合当地条件。我们还希望进行一项研究，评估将国际电信网络和国际电信预警系统应用于当地住房的可行性，以及当地社区对它们的接受程度。因此，我们正申请发展拨款，进行两项小型的初步研究：一项是在实验棚屋进行，比较两种伊滕和ITWS产品在当地情况下与不同杀虫剂一起使用对家庭和社区的保护效果，以确定哪种产品更适合进行大规模试验;第二个方案是在200个当地家庭安装ITEN和ITWS，并在1年后进行随访，以评估安装的难易程度和成本、寿命和社区可接受性。

Long lasting insecticidal nets (LLIN) are a key component of malaria control and are responsible for saving many lives; but they have several drawbacks. About half of people living in malaria endemic areas do not have access to LLINs. Some of this deficit is due to insufficient delivery of nets, but a major factor is LLINS becoming rapidly damaged, resulting in a lifespan less than their intended 3-years. Additionally, there is typically an unequal distribution of nets to certain groups within households. For example, while the youngest children and their mothers are likely to sleep under nets, school age children often have very low access to nets. And even those who do have access to nets are only protected when they are sleeping. We propose a new tool - purpose made insecticide-treated eave nets (ITENs) with insecticide treated window screens (ITWS) for full house screening. ITENs are purpose made netting rolls that are applied to the house under the overhang of the roof and across windows within 30 minutes by local teams using hammer and nails. These interventions have at least three potential advantages over LLINs: they protect everybody in the household; they protect them at all times when they are in the household; and the are potentially much more durable than LLINs, giving up to 5 years' protection and making them highly cost effective (up to $1.75 per year per household less than LLINs). ITENs fixed across the eaves of household structures and ITWS on the windows block access to and kill Anopheles mosquitoes at their main access points into houses. Mosquitoes are attracted to houses, try to enter through the eaves or windows, and will come up against insecticides in the interventions, turning the house into a "lure and kill", that not only protect people in the house but also everyone in the community. Preliminary household randomised evaluation of ITENs and ITWS among 80 households in Western Kenya in 2012-14 showed 75% fewer vector mosquitoes in the houses using ITENs, ITWS and LLINs when compared to households using LLINs only. ITENs and ITWS are already available and scalable and can be fitted to any type of house.ITENs and ITWS have advantages over LLINs for the application of insecticides. LLINS are touched daily and washed regularly, limiting the range of chemicals which can be applied. ITENs and ITWS are compatible with a wider range of insecticides. This will be greatly advantageous because insecticides used for malaria control are becoming less effective in Africa due to the growing resistance of mosquitoes - and particularly because resistance is a local phenomenon: chemicals that work in one place may be ineffective in another so it is vital to have a wide choice of insecticides. In addition, ITENs and ITWS can be made from denser, more durable material. This not only makes them more physically durable but allows a greater quantity of insecticide to be impregnated, killing more mosquitoes, even resistant ones, and making the effect last longer. We propose in due course to undertake a large-scale cluster randomised trial with epidemiological endpoints in Tanzania. However, before this is possible it is necessary to investigate which particular combination of insecticides, is appropriate to the local conditions. We also wish to undertake a study to assess how feasible it is to fit ITENs and ITWS to local houses and how acceptable local communities find them. We are therefore applying for a development grant for a 2 small preliminary studies: one in experimental huts, which will be conducted to compare the household and community protective efficacy of 2 ITEN and ITWS products with different insecticides in local conditions to see which is better to take forward to a large scale trial; and a second in which 200 local houses are fitted with ITENs and ITWS and followed up after 1 year to assess ease and cost of fitting, longevity and community acceptability.