Acceptability of insecticide-treated clothing for malaria prevention among migrant rubber tappers in Myanmar: a cluster-randomized non-inferiority crossover trial

Abstract

BackgroundInsecticide-treated clothing (ITC) has long been used for military and outdoor recreational purposes and there is substantial evidence to show that it can protect against arthropod biting. As a complementary vector control measure, ITC could be used to address outdoor transmission of malaria, particularly among mobile and migrant populations and night-time workers such as rubber tappers, who may be beyond the reach of core interventions. However, more information is required on acceptability and preferences of target groups towards ITC to understand whether it could be a viable strategy in Myanmar.MethodsA cluster-randomized, double-blind, non-inferiority crossover trial was performed to determine acceptability of ITC versus identical, untreated clothing (NTC) among migrant rubber tappers. The study took place between January and May 2015 with 234 participants in 16 clusters in Thanbyuzayat Township, Mon State, Myanmar. Participants were randomly assigned to the order of clothing distribution and followed up at 2, 4 and 6 week intervals. Acceptability was assessed through structured questionnaires, focus group discussions and in-depth interviews. A cluster-level non-inferiority analysis was conducted using STATA, while qualitative data were digitally recorded, transcribed and content-analysed to identify patterns and themes, and managed thematically in Excel 2010®.ResultsAcceptability of both types of clothing was high. ITC was deduced to be non-inferior to NTC for seven out of eight indicators regarding perceptions (looks nice, is durable, is pleasant to wear for nighttime work, reduces mosquito bites, would recommend the clothing, would buy the clothing, like the clothing overall). A high proportion of respondents reported that the clothing reduced mosquito bites (ITC-98%; NTC-94%). Clothing was worn regularly (about 11 times in the previous two weeks). The most common reasons for not wearing the clothing every night were that it was being washed or dried, or the participant did not go to work.ConclusionsThe high level of acceptability suggests that ITC could be an appropriate strategy for personal protection amongst migrant rubber tappers in outdoor transmission settings in Myanmar. However, more research is needed into the feasibility and protective efficacy of ITC before it can be considered for wider roll-out. Trial registration Clinical trials ACTRN12615000432516

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“…Wearing clothes that are long enough to cover arms and legs and stockings to cover feet can provide significant protection against malaria in the evenings, as our study findings indicate. Insecticidetreated clothing has also been provided to outdoor workers in various setting to protect them against mosquito bites [41,42]. In a study in Nigeria, protective clothing given to children under 5 years was reported to increase protection against malaria infection and anemia status [43].…”

Human and Simian Malaria in the Greater Mekong Subregion and Challenges for Elimination

“…High levels of malaria transmission occurring in forest-fringe areas of Southeast Asia is explained by movements of people in search of forest products and exposure to many highly efficient vector species that have adapted to forest ecotypes [66,85,102,103]. [92,109], or provide conditions that are similar to this vector's natural habitat [110]. This ecological adaptation in human settlements and shaded plantations contributes to outdoor transmission among rubber tappers.…”

“…was abundant in rubber plantations in Myanmar [109] and An. baimaii (molecularly identified) adults were caught from human landing collections in Wae Kha Mi, Mon State, the site of an acceptability study of permethrintreated clothing [110]. from immature rubber plantations, nine from mature rubber plantations, five from secondary forests and one from the rural village [105] (Tangena Julie-Ann, personal communication).…”

Creating mosquito-free outdoor spaces using transfluthrin-treated chairs and ribbons

“…Several intervention options have been proposed as candidates for closing these malaria transmission gaps [18]. Examples include: (a) outdoor-baited traps [19,20], (b) attractive targeted sugar baits [21], (c) pyrethroidtreated clothing [22,23], zooprophylaxis [24] and repellents [25] among others. Topical repellents applied on human skin are widely available for personal protection in some areas.…”