Insecticide Treated Polyethylene Sheeting for Prevention of Malaria in Emergencies
Condition: Malaria
MeSH terms: Malaria; Emergencies
Study type: Interventional
Phase: Phase 3

Summary: 
      A Phase III malaria prevention trial was conducted in two camps of Liberian refugees in
      Sierra Leone using Insecticide Treated Polyethylene Sheeting (ITPS) or untreated polyethylene
      sheeting (UPS) randomly deployed to defined sectors of each camp. The ITPS was impregnated
      with pyrethroid insecticide during manufacture. In Largo camp the ITPS or UPS was attached to
      inner walls and ceilings of shelters, while in Tobanda the ITPS or UPS was used to line the
      ceiling and roof only. Cohorts of children up to 3 years of age were cleared of malaria
      parasites and monitored for up to 8 months post construction for possible malaria
      re-infection. Installation teams and refugee groups were blinded as to whether the sheeting
      was insecticide treated or not.
    

Detailed description: 
      During the last decade public and private sector organisations, under the leadership of the
      Roll Back Malaria (RBM) Initiative, have recognised the need to work together to bring
      complementary expertise to the task of identifying and developing vector control tools
      appropriate to humanitarian crises. Insecticide Treated Polyethylene Sheeting (ITPS), is one
      such tool emerging from this process and is being produced commercially. ITPS is based on the
      standard polyethylene sheeting that is issued routinely as temporary shelter for people
      affected by emergencies. During manufacture the pyrethroid insecticide, deltamethrin, is
      extruded with the polyethylene into three-ply laminated sheets, comprising an inner
      low-density laminate and two, outer high-density laminates. The insecticide release
      characteristics enable the deltamethrin to diffuse slowly to the outer surfaces and to become
      available for pick-up by any insect that lands on the surface. Consequently ITPS has dual
      purpose: to provide shelter but with vector-control potential. Deployment and erection of
      ITPS is done in the same way as standard tarpaulin shelters.

      Until now evaluation of ITPS has been limited to small scale entomological testing in
      scientifically controlled environment 'entomological platforms' in Asian and 'experimental
      huts' in rural African settings (Refer to Citation Section). Before any novel control tool
      can go forward for recommendation by the WHO, or be used routinely in humanitarian crises,
      clear demonstration of impact on malaria morbidity in emergency refugee settings is
      essential. A Phase III field evaluation was therefore conducted to evaluate the impact of
      ITPS on malaria incidence in young children in an area of intense transmission. A unique
      feature of this trial was its setting - a true emergency - in two newly built refugee camps
      for Liberian refugees displaced to Sierra Leone. The findings offer insight into the
      effectiveness of ITPS when used in a scenario for which it was purposefully designed.
    

Intervention name(s): Insecticide Treated Polyethylene Sheeting; Untreated Plastic Sheeting
Intervention type(s): Other; Other
Intervention description(s): Insecticide Treated Polyethylene Sheeting is based on the standard polyethylene sheeting that is issued routinely as temporary shelter for people affected by emergencies. During manufacture the pyrethroid insecticide, deltamethrin, is extruded with the polyethylene into three-ply laminated sheets, comprising an inner low-density laminate and two, outer high-density laminates. The insecticide release characteristics enable the deltamethrin to diffuse slowly to the outer surfaces and to become available for pick-up by any insect that lands on the surface.; Standard polyethylene sheeting that is issued routinely as temporary shelter for people affected by emergencies. Standard untreated plastic sheeting is Identical to ITPS but without the incorporation of insecticide.
Other intervention name(s): Zerofly
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Prevention
Keywords: Malaria Prevention Refugee Emergency; Malaria, Falciparum C03.752.530.650