The role of human and mosquito behaviour in the efficacy of a house-based intervention.

Housing improvement such as blocking eaves and screening windows can help in reducing exposure to indoor biting mosquitoes. The impacts of physical barriers could potentially be boosted by the addition of a mechanism that kills mosquitoes as they attempt to enter the house. One example is to combine household screening with EaveTubes, which are insecticide-treated tubes inserted into closed eaves that attract and kill host-searching mosquitoes. The epidemiological impact of screening + EaveTubes is being evaluated in a large cluster randomized trial in Cote d'Ivoire. The study presented here is designed as a complement to this trial to help better understand the functional roles of screening and EaveTubes. We began by evaluating householder behaviour and household condition in the study villages. This work revealed that doors (and to some extent windows) were left open for large parts of the evening and morning, and that even houses modified to make them more 'mosquito proof' often had possible entry points for mosquitoes. We next built two realistic experimental houses in a village to enable us to explore how these aspects of behaviour and household quality affected the impact of screening and EaveTubes. We found that screening could have a substantial impact on indoor mosquito densities, even with realistic household condition and behaviour. By contrast, EaveTubes had no significant impact on indoor mosquito density, either as a stand-alone intervention or in combination with screening. However, there was evidence that mosquitoes recruited to the EaveTubes, and the resulting mortality could create a community benefit. These complementary modes of action of screening and EaveTubes support the rationale of combining the technologies to create a 'Lethal House Lure'. This article is part of the theme issue 'Novel control strategies for mosquito-borne diseases'.

Semi-field evaluation of the cumulative effects of a "Lethal House Lure" on malaria mosquito mortality.

BACKGROUND: There is growing interest in the potential to modify houses to target mosquitoes with insecticides or repellents as they search for human hosts. One version of this 'Lethal House Lure' approach is the In2Care® EaveTube, which consists of a section of polyvinyl chloride (PVC) pipe fitted into a closed eave, with an insert comprising electrostatic netting treated with insecticide powder placed inside the tube. Preliminary evidence suggests that when combined with screening of doors and windows, there is a reduction in entry of mosquitoes and an increase in mortality. However, the rate of overnight mortality remains unclear. The current study used a field enclosure built around experimental huts to investigate the mortality of cohorts of mosquitoes over multiple nights. METHODS: Anopheles gambiae sensu lato mosquitoes were collected from the field as larvae and reared through to adult. Three-to-five days old adult females were released inside an enclosure housing two modified West African style experimental huts at a field site in M'be, Côte d'Ivoire. Huts were either equipped with insecticide-treated tubes at eave height and had closed windows (treatment) or had open windows and open tubes (controls). The number of host-seeking mosquitoes entering the huts and cumulative mortality were monitored over 2 or 4 days. RESULTS: Very few (0-0.4%) mosquitoes were able to enter huts fitted with insecticide-treated tubes and closed windows. In contrast, mosquitoes continually entered the control huts, with a cumulative mean of 50-80% over 2 to 4 days. Baseline mortality with control huts was approximately 2-4% per day, but the addition of insecticide-treated tubes increased mortality to around 25% per day. Overall cumulative mortality was estimated to be up to 87% over 4 days when huts were fitted with tubes. CONCLUSION: Only 20-25% of mosquitoes contacted insecticide-treated tubes or entered control huts in a given night. However, mosquitoes continue to host search over sequential nights, and this can lead to high cumulative mortality over 2 to 4 days. This mortality should contribute to community-level reduction in transmission assuming sufficient coverage of the intervention.

Semi-field studies to better understand the impact of eave tubes on mosquito mortality and behaviour.

BACKGROUND: Eave tubes are a type of housing modification that provide a novel way of delivering insecticides to mosquitoes as they attempt to enter the house. The current study reports on a series of semi-field studies aimed at improving the understanding of how eave tubes might impact mosquito mortality and behaviour. METHODS: Experiments were conducted using West African style experimental huts at a field site in M'be, Côte d'Ivoire. Huts were modified in various ways to determine: (i) whether mosquitoes in this field setting naturally recruit to eave tubes; (ii) whether eave tubes can reduce house entry even in the absence of screening; (iii) whether mosquitoes suffer mortality if they attempt to exit a house via treated eave tubes; and, (iv) whether screening and eave tubes might deflect mosquitoes into neighbouring houses without the intervention. RESULTS: Ninety percent more mosquitoes (Anopheles gambiae sensu lato, and other species) entered huts through open eaves tubes compared to window slits. The addition of insecticide-treated eave tubes reduced mosquito entry by 60%, even when windows remained open. Those mosquitoes that managed to enter the huts exhibited a 64% reduction in blood feeding and a tendency for increased mortality, suggesting contact with insecticide-treated inserts prior to hut entry. When An. gambiae mosquitoes were deliberately introduced into huts with treated eave tubes, there was evidence of six times increase in overnight mortality, suggesting mosquitoes can contact treated eave tube inserts when trying to exit the hut. There was no evidence for deflection of mosquitoes from huts with screening, or screening plus eave tubes, to adjacent unmodified huts. CONCLUSIONS: Eave tubes are a potentially effective way to target Anopheles mosquitoes with insecticides. That treated eave tubes can reduce mosquito entry even when windows are open is a potentially important result as it suggests that eave tubes might not need to be combined with household screening to have an impact on malaria transmission. The absence of deflection is also a potentially important result as coverage of eave tubes and/or screening is unlikely to be 100% and it is important that households that do not have the technology are not disadvantaged by those that do.