title: To assess whether indoor residual spraying can provide additional protection against clinical malaria over current best practice of long-lasting insecticidal mosquito nets in The Gambia: study protocol for a two-armed cluster-randomised trial.
abstract: BACKGROUND
  Recently, there has been mounting interest in scaling-up vector control against malaria in Africa. It needs to be determined if indoor residual spraying (IRS with DDT) will provide significant marginal protection against malaria over current best practice of long-lasting insecticidal nets (LLINs) and prompt treatment in a controlled trial, given that DDT is currently the most persistent insecticide for IRS.
  
  
  METHODS
  A 2 armed cluster-randomised controlled trial will be conducted to assess whether DDT IRS and LLINs combined provide better protection against clinical malaria in children than LLINs alone in rural Gambia. Each cluster will be a village, or a group of small adjacent villages; all clusters will receive LLINs and half will receive IRS in addition. Study children, aged 6 months to 13 years, will be enrolled from all clusters and followed for clinical malaria using passive case detection to estimate malaria incidence for 2 malaria transmission seasons in 2010 and 2011. This will be the primary endpoint. Exposure to malaria parasites will be assessed using light and exit traps followed by detection of Anopheles gambiae species and sporozoite infection. Study children will be surveyed at the end of each transmission season to estimate the prevalence of Plasmodium falciparum infection and the prevalence of anaemia.
  
  
  CONCLUSIONS
  Practical issues concerning intervention implementation, as well as the potential benefits and risks of the study, are discussed.
  
  
  BACKGROUND
  ISRCTN01738840 - Spraying And Nets Towards malaria Elimination (SANTE).
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Pinder
authors.forename: Musa
authors.initials: M
authors.lastname: Jawara
authors.forename: Lamin B S
authors.initials: LB
authors.lastname: Jarju
authors.forename: Ballah
authors.initials: B
authors.lastname: Kandeh
authors.forename: David
authors.initials: D
authors.lastname: Jeffries
authors.forename: Manuel F
authors.initials: MF
authors.lastname: Lluberas
authors.forename: Jenny
authors.initials: J
authors.lastname: Mueller
authors.forename: David
authors.initials: D
authors.lastname: Parker
authors.forename: Kalifa
authors.initials: K
authors.lastname: Bojang
authors.forename: David J
authors.initials: DJ
authors.lastname: Conway
authors.forename: Steve W
authors.initials: SW
authors.lastname: Lindsay
mesh_terms: D000293:Adolescent; D000336:Aerosols; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003634:DDT / Q000009:adverse effects; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D057148:Insecticide-Treated Bednets; D007306:Insecticides / Q000009:adverse effects; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D009032:Mosquito Control / Q000379:methods*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D019035:Rural Health Services; D012621:Seasons
chemical_list: D000336:Aerosols; D007306:Insecticides; D003634:DDT