Evidence map›Paper›PMID 33640068›Full record

Trial reportLancet (London, England)2021

Effectiveness and cost-effectiveness of reactive, targeted indoor residual spraying for malaria control in low-transmission settings: a cluster-randomised, non-inferiority trial in South Africa.

David Bath, Jackie Cook, John Govere, Phillemon Mathebula, Natashia Morris, Khumbulani Hlongwana, Jaishree Raman, Ishen Seocharan, Alpheus Zitha, Matimba Zitha and 12 more

Registry-linked trialOpen access · hybridAbstract readRandomized Controlled TrialEquivalence Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02556242 (From Malaria Control to Sustainable Elimination), which is not on this map. Cited by 17 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 4 pooled it
4.7field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02556242 phase4completednot on this map

From Malaria Control to Sustainable Elimination: Cluster Randomised Trial Comparing Targeted Versus Generalised Vector Control in South Africa

TypeinterventionalSponsorLondon School of Hygiene and Tropical MedicineRan2015 to 2017Enrolled393,387ConditionsMalariaArmsTargeted indoor residual spraying, Generalised Indoor residual spraying
3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 4 syntheses or guidelines pooled it, 31 citations in OpenAlex.

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  6. Mapping residual malaria transmission in Vietnam.The Lancet regional health. Western Pacific · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

22 authors at 9 institutions in 2 countries.

David BathDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: david.bath@lshtm.ac.uk.
Jackie CookDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
John GovereWits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Phillemon MathebulaWits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Natashia MorrisHealth GIS Centre, South African Medical Research Council, Durban, South Africa.
Khumbulani HlongwanaSchool of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Jaishree RamanWits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Emerging, Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa.
Ishen SeocharanBiostatistics Unit, South African Medical Research Council, Durban, South Africa.
Alpheus ZithaMpumalanga Provincial Malaria Control Programme, Nelspruit, South Africa.
Matimba ZithaWits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Aaron MabuzaMpumalanga Provincial Malaria Control Programme, Nelspruit, South Africa.
Frans MbokaziMpumalanga Provincial Malaria Control Programme, Nelspruit, South Africa.
Elliot MachabaLimpopo Provincial Malaria Control Programme, Polokwane, South Africa.
Erik MabundaLimpopo Provincial Malaria Control Programme, Polokwane, South Africa.
Eunice JamesboyWits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Emerging, Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
Joseph BiggsDepartment of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK.
Chris DrakeleyDepartment of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK.
Devanand MoonasarSchool of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; South Africa National Malaria Programme, National Department of Health, Pretoria, South Africa.
Rajendra MaharajOffice of Malaria Research, South African Medical Research Council, Durban, South Africa; Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa.
Maureen CoetzeeWits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Emerging, Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
Catherine PittDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
Immo KleinschmidtDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Southern African Development Community Malaria Elimination Eight Secretariat, Windhoek, Namibia.
London School of Hygiene & Tropical Medicine · GBUniversity of the Witwatersrand · ZAUniversity of Mpumalanga · ZANational Health Laboratory Service · ZASouth African Medical Research Council · ZAUniversity of Limpopo · ZADepartment of Health · ZAUniversity of KwaZulu-Natal · ZAUniversity of Pretoria · ZA

Funding

Medical Research Council MR/L00433X/1Medical Research Council MR/R010161/1
6 · The paper itself

Abstract

backgroundIncreasing insecticide costs and constrained malaria budgets could make universal vector control strategies, such as indoor residual spraying (IRS), unsustainable in low-transmission settings. We investigated the effectiveness and cost-effectiveness of a reactive, targeted IRS strategy.

methodsThis cluster-randomised, open-label, non-inferiority trial compared reactive, targeted IRS with standard IRS practice in northeastern South Africa over two malaria seasons (2015-17). In standard IRS clusters, programme managers conducted annual mass spray campaigns prioritising areas using historical data, expert opinion, and other factors. In targeted IRS clusters, only houses of index cases (identified through passive surveillance) and their immediate neighbours were sprayed. The non-inferiority margin was 1 case per 1000 person-years. Health service costs of real-world implementation were modelled from primary and secondary data. Incremental costs per disability-adjusted life-year (DALY) were estimated and deterministic and probabilistic sensitivity analyses conducted. This study is registered with ClinicalTrials.gov, NCT02556242.

findingsMalaria incidence was 0·95 per 1000 person-years (95% CI 0·58 to 1·32) in the standard IRS group and 1·05 per 1000 person-years (0·72 to 1·38) in the targeted IRS group, corresponding to a rate difference of 0·10 per 1000 person-years (-0·38 to 0·59), demonstrating non-inferiority for targeted IRS (p<0·0001). Per additional DALY incurred, targeted IRS saved US$7845 (2902 to 64 907), giving a 94-98% probability that switching to targeted IRS would be cost-effective relative to plausible cost-effectiveness thresholds for South Africa ($2637 to $3557 per DALY averted). Depending on the threshold used, targeted IRS would remain cost-effective at incidences of less than 2·0-2·7 per 1000 person-years. Findings were robust to plausible variation in other parameters.

interpretationTargeted IRS was non-inferior, safe, less costly, and cost-effective compared with standard IRS in this very-low-transmission setting. Saved resources could be reallocated to other malaria control and elimination activities.

fundingJoint Global Health Trials.

Indexed as

Cost-Benefit AnalysisHumansInsecticidesMalariaMosquito ControlSouth AfricaInsecticides

Identifiers

PMID33640068
PMCPMC7910276
OpenAlexW3132521651

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.