Cloth wraps treated with ‘dirt cheap’ insecticide cut malaria cases in babies | Global health

From Africa to Latin America to Asia, babies have been carried in cloth slings on their mothers’ backs for centuries. Today, the practice of several generations of women could become a vital tool in the fight against malaria.

Ugandan researchers found that treating the envelopes with the insect repellent Permethrin reduced malaria rates by two-thirds in the infants they carried.

Malaria kills more than 600,000 people a year, most of them African children under the age of five.

The trial involved 400 mothers and babies, aged around six months, in Kasese, a rural, mountainous region in western Uganda. Half received body wraps, known locally as lesustreated with Permethrin and half used standard untreated packages that had been soaked in water as a “fake” repellent.

The researchers followed them for six months to see which babies developed malaria, re-treating the envelopes once a month.

Babies transported in the treated envelopes were two-thirds less likely to develop malaria. In this group, there were 0.73 cases per 100 babies each week, and in the other, 2.14.

A mother attending a community session on the trial results stood up to tell the gathering: “I’ve had five children. This is the first one I’ve worn in a treated sling, and it’s the first time I’ve had a child who hasn’t had malaria.”

The results made everyone “extremely excited,” said co-lead researcher Edgar Mugema Mulogo, a professor of public health at Mbarara University of Science and Technology in Uganda.

“We suspected there would be potential benefits – what was quite remarkable was the scale. »

His co-principal investigator, Dr. Ross Boyce, a professor at the University of North Carolina at Chapel Hill, was so amazed that he said they should reanalyze the results to double-check them. “I wasn’t sure it would work, to be honest with you,” Boyce said. “But that’s why we study.”

Mosquitoes carrying malaria parasites typically feed at night, which is why bed nets have always played such an important role in fighting the disease.

However, they increasingly bite outside of these times, in the evening or early morning, in what could be an adaptation to mosquito nets.

Mulogo said: “Before you go to bed, when you are out – especially in rural communities, where the kitchens are outside, they probably eat the evening meal outside – we also need to find a solution that ensures that we can avoid bites that can transmit malaria.

Scarves are everywhere in these communities, he explained, used not only to carry infants, but also as shawls, sheets and aprons. He would like to see the treated packaging become part of the suite of tools used to fight malaria in Uganda. There is already demand in the communities that participated in the study, he said.

Health officials in Uganda and international malaria leaders at the World Health Organization have expressed interest in the research. This could help babies, as the protection carried by the mother’s antibodies wanes, often before they can be vaccinated.

It also builds on previous research on shawls in Afghan refugee camps that resulted in similar levels of success. WHO guidelines already recognize the role that permethrin-treated clothing can play as personal protection against malaria.

Mulogo hopes that there can one day be local production of impregnated packaging. “This represents a very good business opportunity for the local industry.”

According to the researchers, a series of steps will need to be taken before any deployment, including proof that the intervention works in other contexts.

Boyce said the insecticide has a good safety profile and has been applied to textiles for years — including by the U.S. military, where he first encountered the idea while serving in Iraq.

Babies carried in permethrin-treated wraps were slightly more likely to develop rashes, at 8.5% versus 6%, although none were bothersome enough for them to withdraw from the study. Boyce and Mulogo say more research will be needed to confirm the safety of the procedure, although the risks will likely be outweighed by the benefits.

Boyce would like to see if treating school uniforms can also reduce malaria rates. But he added that there was no money in the bank accounts yet for the next stages of the search.

He hopes that the simplicity of the intervention will appeal to donors. “My mom can understand what we did. It’s not a specific inhibitor of a fusion protein or anything like that. We took a cloth and we soaked it. And it’s very cheap,” he said.