A recent large-scale trial in Kenya has revealed that Attractive Targeted Sugar Baits (ATSBs), designed to target mosquitoes outdoors, did not significantly decrease the incidence of clinical malaria among children. Conducted over two years in Siaya county, the study involved over 33,000 households and nearly 3,000 children.
Study Design and Implementation
The cluster-randomised trial assigned 70 clusters to either the intervention group, where ATSBs containing dinotefuran were deployed, or to the control group. All clusters received pyrethroid-only long-lasting insecticidal nets to ensure universal coverage against mosquitoes. The ATSBs were installed outside houses and monitored bi-monthly, with replacements every six months. The study aimed to follow three cohorts of children, totaling approximately 1,260 person-years.
- ATSBs reached 99.3% of household structures in intervention clusters.
- A total of 268,268 ATSBs were deployed over the two-year period.
- Malaria incidence showed no significant reduction in the intervention group.
- Community malaria prevalence remained consistent between intervention and control groups.
- Mosquito parity rates did not differ significantly, indicating limited impact on mosquito populations.
Results and Implications
Malaria incidence was slightly higher in the intervention group (1.32 episodes per person-year) compared to the control group (1.20), but this difference was not statistically significant (p = 0.598). Similarly, malaria prevalence among community residents showed no meaningful difference between both groups. The analysis of mosquito populations also did not indicate a substantial impact of ATSBs on mosquito parity rates.
The findings suggest that ATSBs alone may not be sufficient to reduce malaria incidence in the studied setting. Factors such as mosquito resistance to dinotefuran, environmental conditions, or behavioral adaptations may have influenced the lack of effectiveness. Future efforts may need to integrate multiple control strategies to achieve meaningful reductions in malaria transmission. Continuous monitoring and adaptive approaches are essential to address the evolving challenges in malaria control.
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