Anti-larval measures for malaria control in The Gambia

描述（由申请方提供）：拟定研究的重点是评估2种幼虫控制剂球形芽孢杆菌（Bs）和B的能力。苏云israelensis（Bti）（VectoLex（r）和Vectobac（r），Valent Biosciences，美国）用于减少儿童临床疟疾。有效的疟疾控制受到热带不同地区抗药性和杀虫剂抗药性的威胁，幼虫控制可能为有效控制提供新的选择。 幼虫控制在历史上是成功的，但在过去的50年里在很大程度上被忽视了。 最近已证明，有希望的Bs和Bti新制剂对非洲疟疾的主要病媒有很好的控制作用。使用这些产品比化学杀幼虫剂更好，因为它们具有多种作用，并且在一起使用时似乎不会引起抗性的进化。迄今为止，很少有试验测量了Bs和Bti杀幼虫的临床影响，这些试验受到集群内样本量小和集群缺乏复制的阻碍，因此统计功效低。迫切需要进行一项规模更大的重复干预研究，以证明幼虫控制是一种有效的疟疾控制工具，并使国际决策者能够就幼虫控制的相对优点作出知情决策。因此，我们建议在冈比亚开展一项大型集群随机干预试验，以调查幼虫控制降低儿童疟疾发病率的能力。这项研究的结果将为量化使用Bs和Bti在抗击疟疾中的重要性做出重大贡献。

DESCRIPTION (provided by applicant): The proposed research focuses on the assessment of the ability of 2 larval control agents, Bacillus sphaericus (Bs) and B. thuringiensis var. israelensis (Bti) (VectoLex(r) and Vectobac(r), Valent Biosciences, USA) to reduce clinical malaria in children. Effective malaria control is under threat from drug and insecticide resistance in different parts of the tropics, and larval control may offer a new alternative for effective control. Larval control has been historically successful, but has been largely neglected over the last 50 years. Promising new formulations of Bs and Bti have recently been shown to give excellent control of the major vectors of malaria in Africa. Use of these products is better than chemical larvicides since they have multiple actions and do not appear to elicit the evolution of resistance when used together. To date few trials have measured the clinical impact of larviciding with Bs and Bti and these have been hampered by small sample size within clusters and a lack of replication of clusters and hence, low statistical power. A larger intervention study with replication is urgently required to demonstrate the proof of concept that larval control is an effective malaria control tool and to allow informed decision making by international policy makers of the relative merits of larval control. We therefore propose to carry out a large cluster-randomised intervention trial in The Gambia to investigate the ability of larval control to reduce malaria morbidity in children. The results from this study will make a major contribution to quantifying the importance of the use of Bs and Bti in the fight against malaria.