title: Permethrin-treated chaddars and top-sheets: appropriate technology for protection against malaria in Afghanistan and other complex emergencies.
abstract: Insecticide-treated mosquito nets (ITN) provide excellent protection against malaria; however, they have a number of shortcomings that are particularly evident in politically unstable countries or countries at war: not everyone at risk can necessarily afford a net, nets may be difficult to obtain or import, nets may not be suitable for migrants or refugees sleeping under tents or plastic shelter. There is a need to develop cheaper, locally appropriate alternatives for the most impoverished and for victims of complex emergencies. Afghan women, in common with many Muslim peoples of Asia, wear a veil or wrap known as a chaddar to cover the head and upper body. This cloth doubles as a sheet at night, when they are used by both sexes. A randomized controlled trial was undertaken in which 10% of the families of an Afghan refugee camp (population 3950) in north-western Pakistan had their chaddars and top-sheets treated with permethrin insecticide at a dosage of 1 g/m2 while a further 10% had their chaddars treated with placebo formulation. Malaria episodes were recorded by passive case detection at the camp's health centre. From August to November the odds of having a falciparum or vivax malaria episode were reduced by 64% in children aged 0-10 years and by 38% in refugees aged < 20 years in the group using permethrin-treated chaddars and top-sheets. Incidence in refugees over 20 years of age was not significantly reduced. The cost of the permethrin treatment per person protected (US$0.17) was similar to that for treating bednets (and cost only 10-20% of the price of a new bednet). An entomological study simulating real-life conditions indicated that host-seeking mosquitoes were up to 70% less successful at feeding on men sleeping under treated chaddars and some were killed by the insecticide. Permethrin-treated top-sheets and blankets should provide appropriate and effective protection from malaria in complex emergencies. In Islamic and non-Islamic countries in Asia, treated chaddars and top-sheets should offer a satisfactory solution for the most vulnerable who cannot afford treated nets.
authors.affiliation: HealthNet International, Peshawar, Pakistan. m.rowland@lshtm.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Rowland
authors.forename: N
authors.initials: N
authors.lastname: Durrani
authors.forename: S
authors.initials: S
authors.lastname: Hewitt
authors.forename: N
authors.initials: N
authors.lastname: Mohammed
authors.forename: M
authors.initials: M
authors.lastname: Bouma
authors.forename: I
authors.initials: I
authors.lastname: Carneiro
authors.forename: J
authors.initials: J
authors.lastname: Rozendaal
authors.forename: A
authors.initials: A
authors.lastname: Schapira
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan / Q000208:ethnology; D000368:Aged; D000818:Animals; D000852:Anopheles; D002648:Child; D002675:Child, Preschool; D003020:Clothing; D009033:Culicidae; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007306:Insecticides / Q000008:administration & dosage* / Q000191:economics; D016015:Logistic Models; D008288:Malaria / Q000191:economics / Q000208:ethnology / Q000517:prevention & control*; D016778:Malaria, Falciparum / Q000191:economics / Q000208:ethnology / Q000517:prevention & control; D016780:Malaria, Vivax / Q000191:economics / Q000208:ethnology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control / Q000191:economics / Q000379:methods*; D010154:Pakistan / Q000453:epidemiology; D026023:Permethrin; D011722:Pyrethrins / Q000008:administration & dosage* / Q000191:economics; D012036:Refugees; D012307:Risk Factors
chemical_list: D007306:Insecticides; D011722:Pyrethrins; D026023:Permethrin