Insecticide Treated Polyethylene Sheeting for Prevention of Malaria in Emergencies
Insecticide Treated Polyethylene Sheeting for Prevention of Malaria in Emergencies
A Phase III malaria prevention trial was conducted in two camps of Liberian refugees in
 Sierra Leone using Insecticide Treated Polyethylene Sheeting (ITPS) or untreated polyethylene
 sheeting (UPS) randomly deployed to defined sectors of each camp. The ITPS was impregnated
 with pyrethroid insecticide during manufacture. In Largo camp the ITPS or UPS was attached to
 inner walls and ceilings of shelters, while in Tobanda the ITPS or UPS was used to line the
 ceiling and roof only. Cohorts of children up to 3 years of age were cleared of malaria
 parasites and monitored for up to 8 months post construction for possible malaria
 re-infection. Installation teams and refugee groups were blinded as to whether the sheeting
 was insecticide treated or not.
During the last decade public and private sector organisations, under the leadership of the
 Roll Back Malaria (RBM) Initiative, have recognised the need to work together to bring
 complementary expertise to the task of identifying and developing vector control tools
 appropriate to humanitarian crises. Insecticide Treated Polyethylene Sheeting (ITPS), is one
 such tool emerging from this process and is being produced commercially. ITPS is based on the
 standard polyethylene sheeting that is issued routinely as temporary shelter for people
 affected by emergencies. During manufacture the pyrethroid insecticide, deltamethrin, is
 extruded with the polyethylene into three-ply laminated sheets, comprising an inner
 low-density laminate and two, outer high-density laminates. The insecticide release
 characteristics enable the deltamethrin to diffuse slowly to the outer surfaces and to become
 available for pick-up by any insect that lands on the surface. Consequently ITPS has dual
 purpose: to provide shelter but with vector-control potential. Deployment and erection of
 ITPS is done in the same way as standard tarpaulin shelters.

 Until now evaluation of ITPS has been limited to small scale entomological testing in
 scientifically controlled environment 'entomological platforms' in Asian and 'experimental
 huts' in rural African settings (Refer to Citation Section). Before any novel control tool
 can go forward for recommendation by the WHO, or be used routinely in humanitarian crises,
 clear demonstration of impact on malaria morbidity in emergency refugee settings is
 essential. A Phase III field evaluation was therefore conducted to evaluate the impact of
 ITPS on malaria incidence in young children in an area of intense transmission. A unique
 feature of this trial was its setting - a true emergency - in two newly built refugee camps
 for Liberian refugees displaced to Sierra Leone. The findings offer insight into the
 effectiveness of ITPS when used in a scenario for which it was purposefully designed.
Inclusion Criteria:

 -  Resident of LARGO or TOBANDA Refugee Camp, Sierra Leone, West Africa

 -  Child whose guardian has given informed consent for their child to be enrolled into
 monitoring

 -  Child aged 4 months to 3 years

 Exclusion Criteria:

 -  Residents who answer "Yes" to the question, "Do you anticipate/plan on moving out of
 this shelter or camp in the next 6-12 months?"

 -  Children who have a serious illness other than malaria, based on guardian report.

 -  Children who have experienced adverse reactions to Amodiaquine or Artesunate on a
 previous occasion.

 -  Guardians of children who answer "Yes" to the question, "Do you anticipate/plan on
 moving out of this shelter or camp in the next 12 months?"