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Randomized Controlled Trial
. 2013 Aug 14;8(8):e70664.
doi: 10.1371/journal.pone.0070664. eCollection 2013.

Can topical insect repellents reduce malaria? A cluster-randomised controlled trial of the insect repellent N,N-diethyl-m-toluamide (DEET) in Lao PDR

Vanessa Chen-Hussey  1 , Ilona Carneiro, Hongkham Keomanila, Rob Gray, Sihamano Bannavong, Saysana Phanalasy, Steven W Lindsay
Affiliations
Randomized Controlled Trial

Can topical insect repellents reduce malaria? A cluster-randomised controlled trial of the insect repellent N,N-diethyl-m-toluamide (DEET) in Lao PDR

Vanessa Chen-Hussey et al. PLoS One. .

Abstract

Background: Mosquito vectors of malaria in Southeast Asia readily feed outdoors making malaria control through indoor insecticides such as long-lasting insecticidal nets (LLINs) and indoor residual spraying more difficult. Topical insect repellents may be able to protect users from outdoor biting, thereby providing additional protection above the current best practice of LLINs.

Methods and findings: A double blind, household randomised, placebo-controlled trial of insect repellent to reduce malaria was carried out in southern Lao PDR to determine whether the use of repellent and long-lasting insecticidal nets (LLINs) could reduce malaria more than LLINs alone. A total of 1,597 households, including 7,979 participants, were recruited in June 2009 and April 2010. Equal group allocation, stratified by village, was used to randomise 795 households to a 15% DEET lotion and the remainder were given a placebo lotion. Participants, field staff and data analysts were blinded to the group assignment until data analysis had been completed. All households received new LLINs. Participants were asked to apply their lotion to exposed skin every evening and sleep under the LLINs each night. Plasmodium falciparum and P. vivax cases were actively identified by monthly rapid diagnostic tests. Intention to treat analysis found no effect from the use of repellent on malaria incidence (hazard ratio: 1.00, 95% CI: 0.99-1.01, p = 0.868). A higher socio-economic score was found to significantly decrease malaria risk (hazard ratio: 0.72, 95% CI: 0.58-0.90, p = 0.004). Women were also found to have a reduced risk of infection (hazard ratio: 0.59, 95% CI: 0.37-0.92, p = 0.020). According to protocol analysis which excluded participants using the lotions less than 90% of the time found similar results with no effect from the use of repellent.

Conclusions: This randomised controlled trial suggests that topical repellents are not a suitable intervention in addition to LLINs against malaria amongst agricultural populations in southern Lao PDR. These results are also likely to be applicable to much of the Greater Mekong Sub-region.

Trial registration: This trial is registered with number NCT00938379.

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Conflict of interest statement

Competing Interests: Please note that the authors have declared that no competing interests exist. Both the 15% DEET and the placebo formulations were kindly donated by SC Johnson, who had no part in the design and analysis of this study. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Location of study villages in Attapeu and Sekong provinces in Southern Lao PDR.
Figure 2
Figure 2. Progress of households from recruitment to Intention to Treat (ITT) and According to Protocol (ATP) analysis.
See this image and copyright information in PMC

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SWL is supported by the Research and Policy for Infectious Disease Dynamics Program of the Science and Technology Directory, Department of Homeland Security, and Fogarty International Center, National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.