Discussion
malaria, infections, Infection
MALARIA, INFECTIONS, MALARIA, INFECTION
New paradigms of vector control tools are urgently needed if we are to continue the downward trajectory of malaria transmission that has been achieved over the past few decades. Housing modifications are a paradigm that has rarely been explored in cluster randomised trials. In this large trial, EaveTubes combined with house screening demonstrated a strong impact on malaria case incidence in Côte d’Ivoire [The endline prevalence survey took place at the end of the transmission season, 18 months after the intervention had been installed. Bed net trials in Tanzania have shown that an intervention’s impact on prevalence can differ substantially in accordance with the timing of the survey, which may be a reflection of seasonality of transmission, or the ageing of the intervention [Infection prevalence was highest in children aged between 5 and 10 years old in both arms at endline. Together with children aged 10–15 years, these children were the least likely to have slept under a net—a finding that has been seen elsewhere in malaria endemic settings [There were considerable discrepancies between the results of the RDTs and the results of the microscopy. One explanation for differences between the diagnostics could be that RDTs are still detecting circulating HRP-2 from previous infections; however, only a small proportion of participants reported receiving treatment for malaria in the previous 2 weeks, the majority of whom were either positive by RDT or both microscopy and RDT. Other potential reasons for discrepancies could be other circulating infections causing false positives in RDTs [One of the barriers to undertaking large scale trials, such as the Screening + EaveTubes trial in Côte d’Ivoire, is the limited number of funders who are willing or able to fund large cluster randomised control trials. Malaria case incidence can be an expensive and logistically challenging metric to collect, whereas prevalence is considerably cheaper to measure than incidence, due to the nature of the data collection (continuous monitoring of cohorts for incidence vs one off survey for prevalence). To illustrate efforts involved in active case detection for the incidence measure in this trial, the team undertook over 60,000 visits to approximately 2000 children over a 2-year period [