Effect of two different house screening interventions on exposure to malaria vectors and on anaemia in children in The Gambia: a randomised controlled trial
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Background House screening should protect people against malaria. We assessed whether two types of house screening--full screening of windows, doors, and closing eaves, or installation of screened ceilings--could reduce house entry of malaria vectors and frequency of anaemia in children in an area of seasonal malaria transmission.Methods During 2006 and 2007, 500 occupied houses in and near Farafenni town in The Gambia, an area with low use of insecticide-treated bednets, were randomly assigned to receive full screening, screened ceilings, or no screening (control). Randomisation was done by computer-generated list, in permuted blocks of five houses in the ratio 2:2:1. Screening was not treated with insecticide. Exposure to mosquitoes indoors was assessed by fortnightly light trap collections during the transmission season. Primary endpoints included the number of female Anopheles gambiae sensu lato mosquitoes collected per trap per night. Secondary endpoints included frequency of anaemia (haemoglobin concentration <80 g/L) and parasitaemia at the end of the transmission season in children (aged 6 months to 10 years) who were living in the study houses. Analysis was by modified intention to treat (ITT), including all randomised houses for which there were some outcome data and all children from those houses who were sampled for haemoglobin and parasitaemia. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN51184253.Findings 462 houses were included in the modified ITT analysis (full screening, n=188; screened ceilings, n=178; control, n=96). The mean number of A gambiae caught in houses without screening was 37.5 per trap per night (95% CI 31.6-43.3), compared with 15.2 (12.9-17.4) in houses with full screening (ratio of means 0.41, 95% CI 0.31-0.54; p<0.0001) and 19.1 (16.1-22.1) in houses with screened ceilings (ratio 0.53, 0.40-0.70; p<0.0001). 755 children completed the study, of whom 731 had complete clinical and covariate data and were used in the analysis of clinical outcomes. 30 (19%) of 158 children from control houses had anaemia, compared with 38 (12%) of 309 from houses with full screening (adjusted odds ratio [OR] 0.53, 95% CI 0.29-0.97; p=0.04), and 31 (12%) of 264 from houses with screened ceilings (OR 0.51, 0.27-0.96; p=0.04). Frequency of parasitaemia did not differ between intervention and control groups.Interpretation House screening substantially reduced the number of mosquitoes inside houses and could contribute to prevention of anaemia in children.Funding Medical Research Council.
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Closed eaves, together with modern housing elements such as metal roofs, window screening, and improved doors, are associated with reduced malaria burdens.
“and that closed eaves, together with modern housing elements, such as metal roofs, window screening, and improved doors, are associated with reduced malaria burdens.10, 11, 12, 13”
From Impact and cost-effectiveness of a lethal house lure against malaria transmission in central Côte d'Ivoire: a two-arm, cluster-randomised controlled trial (2021) · cites this paper as [12]
The study was powered to detect a 50% reduction in mosquito density, requiring seven houses per cluster for human landing catch captures.
“For the entomological sampling, we powered the study to detect a 50% reduction in mosquito density, consistent with semi-field testing of Eave Tubes19, 20 and other randomised controlled trials evaluating the entomological effect of house modifications.12, 29 On the basis of baseline data, this sample size calculation required seven houses per cluster for the human landing catch captures.”
From Impact and cost-effectiveness of a lethal house lure against malaria transmission in central Côte d'Ivoire: a two-arm, cluster-randomised controlled trial (2021) · cites this paper as [12]
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- Authors
- Kirby, M. J., Ameh, D., Bottomley, C., Green, C., Jawara, M., Milligan, P. J., Snell, P. C., Conway, D. J., & Lindsay, S. W.
- Affiliations
- Durham University (GB)
- MRC Unit the Gambia (GM)
- London School of Hygiene & Tropical Medicine (GB)
- University of Bristol (GB)
- Corresponding author
- Lindsay, Steve W
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2009-09
- Volume
- 374
- Issue
- 9694
- Pages
- 998-1009
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC3776946
- OpenAlex
- W2108348528
- Cited by
- 293
- References
- 46
- Citations by year
- 2026: 16 · 2025: 14 · 2024: 17 · 2023: 16 · 2022: 17 · 2021: 25 · 2020: 30 · 2019: 12 · 2018: 20 · 2017: 21 · 2016: 18 · 2015: 23 · 2014: 9 · 2013: 16 · 2012: 17
- FWCI
- 13.11
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Durham Research Online (Durham University) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mosquito-borne diseases and control
- Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
- Keywords
- house screening, Anopheles gambiae, childhood anemia, seasonal malaria transmission, parasitemia, insecticide-treated bednets, Gambia, vector control, child health
- MeSH terms
- Analysis of Variance, Anemia, Animals, Anopheles, Bedding and Linens, Child, Child, Preschool, Female, Gambia, Hemoglobins, Housing, Humans, Insecticides, Interior Design and Furnishings, Male, Morbidity, Mosquito Control, Population Surveillance, Residence Characteristics, Logistic Models, Malaria, Falciparum, Principal Component Analysis
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