Anti-Malaria Home Proofing
Location
Uganda
Sector
Public Health, Nutrition and Water
Type of Investment
Project Stage
Length of Investment
Investment Overview
Ugandan research organisation, Med Biotech Laboratories, received $230k in pilot funding to conduct a field trial of an innovative anti-malaria ‘home proofing’ solution.
The Development Challenge
Malaria is one of the leading causes of death worldwide, with over 400,000 attributable deaths last year, 90% of those occurring in Africa. It is a disease that disproportionately impacts GIF’s target beneficiaries – people living on less than $5/day – many of whom are based in rural areas and unable to afford or access treatment for malaria. In many African nations, malaria is the leading cause of morbidity and mortality, and generates an enormous burden on national healthcare systems – for instance, in Uganda, malaria accounts for between 30% and 50% of outpatient visits and between 15% and 20% of hospital admissions. Deaths are common (particularly in children under 5), and there is strong evidence connecting malaria to a range of adverse outcomes including anaemia, other nutrition deficiency-related indicators (e.g. low birthweight for children of infected pregnant women), and permanent disabilities such as hearing and visual impairments.
The Innovation
The anti-malaria home-proofing innovation involved modifying a traditional home redecoration custom (where surfaces like walls are decorated by smearing a mixture of soil, dung, and ash) by incorporating insecticide into this mix. The mixture had the potential to perform a similar function to indoor residual spraying, whereby mosquitoes are killed if they come into contact with treated surfaces. Prior to our investment, Med Biotech Laboratories (MBL) had conducted laboratory tests with promising results. GIF’s $230k funding (with equal co-funding from Grand Challenges Canada) aimed to help MBL conduct a 3-year field trial to confirm the efficacy of the innovation in the field.
Investment Objective
To test the efficacy and safety of the insecticidal home decoration.
Anti-Malaria Home Proofing in numbers
Attributable deaths from malaria each year
Anti-Malaria Home Proofing Completion Report
Innovation
With over 400,000 attributable deaths in 2016, malaria is one of the leading killers worldwide, but the two leading solutions – insecticide-treated nets and indoor residual spraying – have issues around either adoption or cost-effectiveness. Med Biotech Laboratories (MBL) set out to malaria-proof traditional Ugandan huts – where a plaster of soil, dung and ash is traditionally used to decorate walls and other surfaces – by incorporating insecticide into the mix to provide a cost-effective alternative to residual indoor spraying. MBL conducted laboratory tests with promising results.
Goal of investment
Test the acceptability, safety and efficacy of MBL’s anti-malaria decoration in Uganda by:
• assessing household acceptability of the concept
• testing the safety of the product for household inhabitants and for smearers
• testing the effectiveness of the smears in killing mosquitos
• assess, via a randomized controlled trial, the impact on malaria infections, anemia, and mosquito density in the home
Investment rationale
• Malaria disproportionately impacts GIF’s target beneficiaries and this intervention provided the potential to
i) generate comparable prevention to current methods
ii) be cost-effective,
iii) be more behaviourally suited to Ugandan context.
There is a wide range of potential applications in addition to home proofing for malaria, such as paint to fight other insect-borne diseases, and MBL possessed a strong team of local Ugandan researchers.
Results
• Households accepted the concept.
• This method was less effective at killing mosquitos than the standard spraying procedure, so the trial was ended.
• A change in the study design from household-level to village-level randomization meant that the survey was not powered to detect impact on malaria, anemia, or mosquito density.
• Safety tests for smearers were not informative due to lack of baseline measurement.
• Unanticipated positive outcomes included the first known test of a new rapid diagnostic test, establishment of a new research site, and research finding high levels of asymptomatic malaria in newborns
Key learnings
• Even small-scale studies need to closely align project objectives with measurement strategy.
• Close monitoring of implementation is essential.
• An ancillary finding was that high levels of asymptomatic malaria are prevalent among infants.
This is a potentially important finding for epidemiology and malaria control.
Route to Scale
Given the lack of efficacy, the question of scale-up does not arise. However, a number of international research partnerships were forged by MBL which may lead to new research opportunities and areas of collaboration for future impact.
Click here to download the Anti-Malaria Home Proofing Completion Assessment.