Malaria Clinical Trial
Official title:
Field Evaluation of Malaria Vector Control Using Traditional Plant-based Anti-mosquito Measures in Yunnan Province, P.R. China
Isolated minority communities in China use traditional plant-based methods of mosquito control. This study is evaluating 4 plants used in this way by monitoring mosquitoes entering houses on nights when the plants are being used in this way. A blind, placebo controlled study design will monitor plant use and record mosquito species / numbers caught in CDC light traps indoors over 3 months.
Introduction
One of the greatest challenges to those planning vector control programmes in developing
Countries is the provision of cover to those populations in remote or isolated areas.
Commonly, it is these communities which bear the greatest burden of disease due to location
and inaccessibility to local health care. Yunnan Province is a good example of such
problems. The border region with Laos, Myanmar and Vietnam contributes a high proportion of
all malaria cases in the whole of China, yet few if any disease control initiatives cover
the rural minority peoples and migrant workers who inhabit the region. Comprehensive
ethnobotanical surveys in the area have shown many of the 25 minority peoples living in
isolated communities already use traditional herbal forms of mosquito control utilising
several of the abundant species in the particularly diverse local environment. Having
identified a number of potentially useful plant species being used, in terms of their
availability, sustainability, low cost (free) and known chemical constituents, the
investigators and the local Chinese malaria control officials consider a phase II evaluation
of the most promising candidates is justified. In particular, 4 widely used plants are
traditionally used as fumigants to reduce / prevent mosquitoes entering houses, either by
burning dried or fresh material on the indoor cooking fires each evening, or by spraying
tinctures around entry sites like eaves & windows. Due to the method of use, it would be
very difficult to simulate this in the laboratory, so a simple means of field evaluation has
been chosen.
Materials
The ethnobotanical survey revealed the following plant species as candidates for further
study; Artemesia argyi, Eucalyptus robusta, Eupatorium odoratum, Cinnamomum glanduliferum
Each of these plant species occurs naturally in abundance in the region and collection will
have no significant environmental impact. Moderate amounts (approx 1 Kg) sufficient for each
study will be collected locally in each field site prior to (if used dried) or at the start
of each experiment (fresh).
Methods
Plants will be evaluated under natural user conditions in a randomised and controlled manner
in villages in Xishuangbanna Region, Yunnan, PR China. Village- based studies of several
other mosquito control methods have already been successfully undertaken in this region by
the LSHTM and YIPD team. Villages belonging to one of the ethnic groups using each
traditional method will be selected according to agreement between local health workers from
YIPD and the village elders, availability of plant species, and preliminary survey of vector
species collected indoors with CDC traps. A different village will be selected for each
plant being evaluated. After collecting background entomological data, 6 houses matched for
baseline parameters (such as occupancy level, location, construction & animal proximity) and
being evenly spaced among others in the village (to reduce diversion effects) will be
enrolled into the study. On any one night, 2 will be allocated treatment (use of plant), 2
will be allocated hay (used for cattle bedding) as a negative control, and 2 will be left
unused (to reduce any residual effects). In each case the treatment or control group will be
instructed to place pre-prepared batches of plant material (weighed fresh or dry depending
upon type) onto their cooking fire in the traditional manner in the early evening.
Commercial CDC traps (BioQuip Inc., USA) will be used in / beside the sleeping areas of each
house from 1 hour before sunset to early morning. Catches will be identified by local vector
experts each day to record species and number. House treatment will be rotated each night
using latin square principles to achieve a minimum of 12 replicates of each treatment in
every house (36 nights duration, 216 trap/nights), and will take place during the rainy
(malaria) season (July - Nov 2005) when both plants and vector levels are highest.
In the case of C. glanduliferum, the plant extract (or hay extract) will be sprayed at a
predetermined rate onto eaves & doors / windows in the traditional manner following the same
principles. Efficacy will be determined by comparing mosquito species / numbers caught in
control & treatment houses using appropriate statistical analysis & ANOVA methodologies.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind, Primary Purpose: Prevention
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