[R01] After the flood: Optimal strategies to prevent malaria epidemics caused by severe flooding
Ente: National Institute of Allergy and Infectious Diseases
Scadenza: 2028-08-31
Importo max: $577,512
Paese: US
Descrizione
The increasing frequency of weather extremes such as flooding on the incidence of malaria and other vector-borne diseases is an issue of substantial public health importance. Therefore, there is a need to develop effective mitigation and control strategies. In 2020, we piloted a post-flood malaria chemoprevention intervention in western Uganda. When compared to two neighboring villages where no intervention was deployed, we estimated a 53% reduction (aRR 0.47, 95% CI 0.34 – 0.62, p<.01) in malaria incidence in the six months post-intervention. Building on these results, the scientific aim of this proposal is to evaluate the effectiveness of a targeted malaria chemoprevention intervention with and without larval source management (LSM) to reduce excess disease burden following severe flooding. Our premise is that the intervention will reduce the parasite reservoir during the period when vectors are re-establishing habitats thereby maintaining relatively low levels of transmission until conditions have returned to the pre-flood baseline. Specifically, we will:
Aim 1: Determine the effectiveness of chemoprevention with or without peri-domestic larvicide application to reduce the incidence of P. falciparum malaria after severe flooding. We will conduct a cluster randomized trial in 50 villages (144 clusters) in rural western Uganda to compare: (i) LLIN distribution (control), (ii) LLIN distribution plus three, monthly rounds of DP provided to children ≤12 years of age (DP), and (iii) LLIN+DP with three months of bi-weekly application of larvicide in the peri-domestic space (DP+Bti). Hypothesis: Chemoprevention will achieve a sustained reduction in malaria incidence compared to the control arm.
Aim 2: Elucidate the evolution of vector populations, feeding behaviors, and sporozoite rate in affected villages up to one year after flooding. We will perform weekly surveillance for adult and juvenile Anopheles mosquitoes. Collected mosquitoes will be identified to species and tested for the presence of P. falciparum sporozoites. Hypothesis: Flooding will create conditions favored by An. gambiae complex resulting in predominance of An. gambiae s.s. with potential for emergence of An. arabiensis as important vector.
Aim 3: Evaluate the relative cost-effectiveness of chemoprevention (Aim 3A) and assess social and economic impacts on households (Aim 3B). We will conduct baseline and longitudinal quantitative surveys in sample clusters to evaluate impacts of the interventions on (i) economic activities and income, (ii) health seeking and expenditures, and (iii) mental health and well-being. These data will inform a cost effectiveness analysis of chemoprevention compared to the control (i.e., relative cost per case averted). Hypothesis: Chemoprevention will mitigate negative effects of malaria in the aftermath of a flood.
Research on strategies to reduce the burden of malaria after severe flooding not only benefits local populations but also minimizes the risk
Istituzione: UNIV OF NORTH CAROLINA CHAPEL HILL
PI: Ross Mathew Boyce
Progetto: 5R01AI173558-04
Settori: National Institute of Allergy and Infectious Diseases
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