Impact of four years of annually repeated indoor residual spraying (IRS) with Actellic 300CS on routinely reported malaria cases in an agricultural setting in Malawi.

Indoor residual spraying (IRS) is one of the main vector control tools used in malaria prevention. This study evaluates IRS in the context of a privately run campaign conducted across a low-lying, irrigated, sugarcane estate from Illovo Sugar, in the Chikwawa district of Malawi. The effect of Actellic 300CS annual spraying over four years (2015-2018) was assessed using a negative binomial mixed effects model, in an area where pyrethroid resistance has previously been identified. With an unadjusted incidence rate ratio (IRR) of 0.38 (95% CI: 0.32-0.45) and an adjusted IRR of 0.50 (95% CI: 0.42-0.59), IRS has significantly contributed to a reduction in case incidence rates at Illovo, as compared to control clinics and time points outside of the six month protective period. This study shows how the consistency of a privately run IRS campaign can improve the health of employees. More research is needed on the duration of protection and optimal timing of IRS programmes.

The effect on haemoglobin of the use of iron cooking pots in rural Malawian households in an area with high malaria prevalence: a randomized trial.

BACKGROUND: Innovative low-cost sustainable strategies are required to reduce the high prevalence of iron-deficiency anaemia in developing countries. METHODS: We undertook a community-based randomized controlled intervention trial to assess the effects of cooking in iron or aluminium cooking pots in Malawian households in an area with high malaria prevalence. Analysis was by intention to treat and consistency of use. The primary outcomes were change in haemoglobin and iron status. FINDINGS: The study population comprised 164 participants eating from aluminium cooking pots and 158 from iron cooking pots. The mean haemoglobin change was significantly increased after 6 weeks in adults who consistently ate from an iron cooking pot (+3.6 g/l compared to -3.2 g/l, mean difference between groups 6.8 g/l, 95% CI +0.86, +12.74). In children, no significant haemoglobin change was observed in consistent pot users, although they showed a significant reduction in iron deficiency (iron 8.6 ZP/g and aluminium 10.8 ZP/g, mean difference 2.2 ZP/g, 95% CI +1.08, +3.32). INTERPRETATION: Rural Malawian adults in a high malaria transmission area who consistently consume food prepared in iron cooking pots show a significant rise in haemoglobin after 6 weeks use. Children showed a reduction in iron deficiency, but no significant improvement in haemoglobin, possibly because of their high malaria parasite prevalence. Using iron cooking pots in developing countries could provide an innovative way to prevent iron deficiency and anaemia in malarious areas where regular iron supplementation is problematic.

Acceptability of the use of iron cooking pots to reduce anaemia in developing countries.

OBJECTIVE: To evaluate acceptability, compliance and attitude towards the use of iron pots compared with aluminium pots, for cooking in a community that traditionally did not use iron pots. DESIGN: Randomised trial. SETTING: Two rural Malawian villages. SUBJECTS: Fifty-two households received iron pots and 61 aluminium pots. RESULTS: Pot characteristics were assessed by a questionnaire after 3, 6, 11 and 20 weeks of use. Within households using iron pots there was a significant decrease in acceptability score with usage, from an initial value of 13.7 to 11.4 (range 1-20) Answers to questions concerning cooking characteristics showed that after 3 weeks' use the aluminium pot scored better, whereas after 20 weeks fewer answers differed between the iron and aluminium pot groups. Almost a third of the households planned to continue using iron pots daily after 20 weeks, although they had ready access to their former aluminium pot. The presence of a group of consistent pot users suggests that if households were convinced about daily use, then they were likely to maintain consistent use. Some householders considered that iron pots required less firewood for cooking than aluminium pots. The main problems related to lower acceptability were rusting and pot weight. About 25% of problems with iron pots were unrelated to their cast iron characteristics. Overall 23.4% of the households indicated they would buy an iron pot. CONCLUSIONS: The low acceptability of iron pots for cooking could limit their value as an intervention to control iron-deficiency anaemia. Design modifications and better instructions on pot use should improve acceptability. The study highlights the need to assess the acceptability of interventions in order to facilitate their adoption in traditional communities.