To assess whether addition of pyriproxyfen to long-lasting insecticidal mosquito nets increases their durability compared to standard long-lasting insecticidal mosquito nets: study protocol for a randomised controlled trial.
BACKGROUND
The effectiveness of pyrethroid-treated bednets for malaria control in sub-Saharan Africa is under threat because of high levels of resistance to pyrethroid insecticides in the vectors. Here we assess the durability of polyethylene nets with a novel combination of permethrin, a pyrethroid, with pyriproxyfen, an insect juvenile mimic (PPF-LLIN), in comparison with a typical permethrin-treated long-lasting insecticidal net (LLIN).


METHODS
This is a cluster randomised controlled trial of net durability in Burkina Faso, with clustering at the level of the compound and includes entomological outcome measurements. Half the compounds in each village will be randomly allocated PPF-LLIN and half the LLIN. All sleeping places in a compound will be provided with one type of net. We will distribute the nets at the start of the first transmission season and follow net use at the start and end of each transmission season for 3 years. In one village, bio-efficacy and chemical content will be recorded immediately after net distribution and then at 6, 12, 18, 24, 30 and 36 months. In the other village net survivorship and fabric integrity will be recorded immediately after distribution, and then at 6, 12, 18, 24, 30 and 36 months. Routine measurements of indoor temperature and relative humidity will be made in both villages during the study. Residents will be followed for possible side effects of the PPF-LLIN by surveillance of known asthmatic subjects during the first month post-distribution and pregnancy outcomes will be monitored from antenatal clinic records.


CONCLUSIONS
The protocol is novel on two accounts. Firstly, it is the first to describe the procedure for measuring net durability following recent World Health Organisation (WHO) guidelines. Meeting the minimum requirements set in the guidelines is essential before a new type of net can be recommended by WHO's Pesticide Evaluation Scheme (WHOPES). Secondly, it describes methods to monitor the persistence of an active ingredient that reduces vector fertility and fecundity. If the PPF-LLIN is both effective and persistent it will provide an alternative vector control strategy where pyrethroid-resistant vectors are present.


BACKGROUND
ISRCTN30634670 assigned 13 August 2014.
Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso. n.fale.cnlp@fasonet.bf.
N'Fale
N
Sagnon
School of Biological Sciences and Biomedicine, Durham University, Durham, UK. mpinder@mrc.gm.|Medical Research Council Unit The Gambia, PO Box 273, Banjul, The Gambia. mpinder@mrc.gm.
Margaret
M
Pinder
Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire. tchicaya@hotmail.com.
Emile Fs
EF
Tchicaya
Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso. t.alfred@fasonet.bf.
Alfred B
AB
Tiono
Liverpool School of Tropical Medicine, Liverpool, UK. Faragher@liv.ac.uk.
Brian
B
Faragher
Liverpool School of Tropical Medicine, Liverpool, UK. hranson@liverpool.ac.uk.
Hilary
H
Ranson
School of Biological Sciences and Biomedicine, Durham University, Durham, UK. S.W.Lindsay@durham.ac.uk.
Steve W
SW
Lindsay
D000818:Animals; D000852:Anopheles / Q000469:parasitology*; D002050:Burkina Faso; D004199:Disease Vectors; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006813:Humidity; D057148:Insecticide-Treated Bednets / Q000009:adverse effects; D007306:Insecticides / Q000009:adverse effects; D008288:Malaria / Q000469:parasitology / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D009032:Mosquito Control / Q000295:instrumentation*; D026023:Permethrin / Q000009:adverse effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011725:Pyridines / Q000009:adverse effects; D012621:Seasons; D013696:Temperature; D013997:Time Factors
D007306:Insecticides; D011725:Pyridines; C055613:pyriproxyfen; D026023:Permethrin