title: The effect of small solar powered 'Bͻkͻͻ' net fans on mosquito net use: results from a randomized controlled cross-over trial in southern Ghana.
abstract: Long-lasting insecticidal nets (LLINs) are ineffective malaria transmission prevention tools if they are unused. Discomfort due to heat is the most commonly reported reason for not using nets, but this problem is largely unaddressed. With increasing rural electrification and the dropping price of solar power, fans could improve comfort inside nets and be affordable to populations in malaria endemic areas. Here, results are presented from a pilot randomized controlled cross-over study testing the effect of fans on LLIN use.
  
  
  
  Eighty-three households from two rural communities in Greater Accra, Ghana, randomized into three groups, participated in a 10-month cross-over trial. After a screening survey to identify eligible households, all households received new LLINs. Bͻkͻͻ net fan systems (one fan per member) were given to households in Group 1 and water filters were given to households in Group 2. At mid-point, Group 1 and 2 crossed over interventions. Households in Group 1 and 2 participated in fortnightly surveys on households' practices related to nets, fans and water filters, while households in Group 3 were surveyed only at screening, mid-point and study end. Entomological and weather data were collected throughout the study. Analysis took both 'per protocol' (PP) and 'intention to treat' (ITT) approaches. The mid- and end-point survey data from Group 1 and 2 were analysed using Firth logistic regressions. Fortnightly survey data from all groups were analysed using logistic regressions with random effects.
  
  
  
  Provision of fans to households appeared to increase net use in this study. Although the increase in net use explained by fans was not significant in the primary analyses (ITT odds ratio 3.24, p > 0.01; PP odds ratio = 1.17, p > 0.01), it was significant in secondary PP analysis (odds ratio = 1.95, p < 0.01). Net use was high at screening and even higher after provision of new LLINs and with follow up. Fan use was 90-100% depending on the fortnightly visit.
  
  
  
  This pilot study could not provide definitive evidence that fans increase net use. A larger study with additional statistical power is needed to assess this association across communities with diverse environmental and socio-demographic characteristics.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. olivier.briet@unibas.ch.|University of Basel, Basel, Switzerland. olivier.briet@unibas.ch.
authors.forename: Olivier J T
authors.initials: OJ
authors.lastname: Briët
authors.affiliation: Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.|Center for Applied Malaria Research and Evaluation, Tulane University, New Orleans, USA.
authors.forename: Joshua O
authors.initials: JO
authors.lastname: Yukich
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Constanze
authors.initials: C
authors.lastname: Pfeiffer
authors.affiliation: Green World Health Net, Albuquerque, USA.
authors.forename: William
authors.initials: W
authors.lastname: Miller
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Mulako S
authors.initials: MS
authors.lastname: Jaeger
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Nitin
authors.initials: N
authors.lastname: Khanna
authors.affiliation: National Malaria Control Programme, Accra, Ghana.
authors.forename: Samuel
authors.initials: S
authors.lastname: Oppong
authors.affiliation: Green World Health Net, Albuquerque, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Nardini
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
authors.forename: Collins K
authors.initials: CK
authors.lastname: Ahorlu
authors.affiliation: Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.|Center for Applied Malaria Research and Evaluation, Tulane University, New Orleans, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Keating
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000389:Air Conditioning / Q000295:instrumentation* / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D005191:Family Characteristics; D005260:Female; D005869:Ghana; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control / Q000295:instrumentation* / Q000379:methods*; D012424:Rural Population; D055815:Young Adult
keywords: Fan; Ghana; Hawthorne effect; Insecticide treated net; Malaria; Net use; Solar power