Clinical trial NCT00169117: A Stitch in Time May Save Lives: Turning Poor Bednets Into Good Ones
Official title: A Stitch in Time May Save Lives: Turning Poor Bednets Into Good Ones
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Malaria
Keywords: Mosquito nets
Malaria prevention
Songs
Posters
Net repair
Bednets
Lead sponsor: London School of Hygiene and Tropical Medicine
Sponsor class: OTHER
Collaborators: name: University of Durham
name: Medical Research Council Unit, The Gambia
First posted: 2005-09-15
Enrollment: 772
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: PREVENTION

Brief summary: Although the use of mosquito nets has increased in Africa, many of the nets used are in a poor state, and not an effective barrier against mosquitoes. This pilot study examines whether subsistence farmers in rural Africa can be encouraged to repair their mosquito nets and use their bednets appropriately. Attitudes and practises on sewing and net use were examined in The Gambia and an intervention developed to promote net repair. Songs and posters were used to emphasise the importance of repairing nets and their correct use, and served as aural and visual reminders to repair nets now rather than postpone this household chore. The intervention was aimed at effectively and cheaply turning a poor net into a good one.

Detailed description: Sleeping under an insecticide-treated net protects the sleeper from mosquito bites and is highly effective means of reducing the risk of malaria. Recent studies in The Gambia and Kenya have shown that untreated bednets in good condition can also protect against malaria (51% protection against parasitaemia, 95% CIs 34-64%). However, most children in rural Gambia sleep under untreated nets in poor condition, often with a few holes, and do not close their nets properly at night. These children remain exposed to mosquito bites and the risk of malaria.

This pilot study examines whether subsistence farmers in rural Africa can be encouraged to repair their mosquito nets and use their bednets appropriately. Attitudes and practises on sewing and net use were examined in rural Gambia and an intervention developed to promote net repair. Songs and posters were used to emphasise the importance of repairing nets and their correct use, and served as aural and visual reminders to repair nets now rather than postpone this household chore. The intervention was aimed at effectively and cheaply turning a poor net into a good one.

The intervention was developed and implemented in two neighbouring villages in The Gambia, with each village composing their own songs. There was no formal control village. An internal comparison group was used in which the nets of responders and non-responders living within the same village were compared.The success of the intervention was assessed by: recording the number of nets repaired and used correctly for malarial prevention before and after the intervention; by counts of mosquitoes entering the nets classified according to number of holes and degree of repair; as well as by canvassing participants' opinions.

Eligibility criteria: Inclusion Criteria:

* Community consent
* Willingness to participate in study

Exclusion Criteria:

* None

Primary outcomes:
measure: Number of bednets repaired (pre- vs post intervention)
timeFrame: November 2003
measure: Mean proportion of holes repaired/net (pre- vs post intervention)
timeFrame: November 2003
measure: Reduction in mosquitoes with a good net compared with a poor one (pre-intervention survey).
timeFrame: November 2003
measure: Reduction in mosquitoes with a good net compared with a repaired net (post-intervention survey)
timeFrame: November 2003
Secondary outcomes:
measure: Community acceptability
timeFrame: November 2003
Other outcomes:
Locations:
city: Farafenni
country: Gambia
facility: Medical Research Council Laboratories
Study officials:
affiliation: University of Durham
name: Steven W Lindsay, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: London School of Hygiene and Tropical Medicine, University of London, UK
name: Sian E Clarke, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Durham
name: Catherine Panter-Brick, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Lomas H, Panter-Brick C, Clarke S, Lindsay S, Pinder M & Walraven G. (2004). A community intervention to repair bed nets for malaria prevention in the Gambia [abstract]. Annals of Human Biology, 31(1): 116
citation: Panter-Brick C, Clarke SE, Lomas H, Pinder M, Lindsay SW. Culturally compelling strategies for behaviour change: a social ecology model and case study in malaria prevention. Soc Sci Med. 2006 Jun;62(11):2810-25. doi: 10.1016/j.socscimed.2005.10.009. Epub 2005 Dec 13.