Impact of a Spatial Repellent on Malaria Incidence in Two Villages in Sumba, Indonesia

Din Syafruddin Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Michael J. Bangs Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Dian Sidik Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Iqbal Elyazar Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Puji BS Asih Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Krisin Chan Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Siti Nurleila Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Christian Nixon Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Joko Hendarto Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Isra Wahid Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Hasanuddin Ishak Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Claus Bøgh Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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John P. Grieco Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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Nicole L. Achee Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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J. Kevin Baird Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia; Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand; Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; The Sumba Foundation, Bali, Indonesia; Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

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A randomized, double-blinded, placebo-controlled study was conducted to examine the effect of spatial repellent (SR) in households at risk of malaria in Indonesia. Following presumptive radical cure for malaria in 180 adult men representing sentinels of new infection in four clusters within two villages, all households were given either metofluthrin or placebo mosquito coils. Weekly blood smear screening and human-landing mosquito catches were done throughout the 6 months intervention. Malaria infections occurred in 61 subjects living in placebo households and 31 subjects living in SR coil households, suggesting a 52% protective effect of SR. Likewise, anopheles indoor human landing rates were 32% lower in homes receiving SR coils. Differences in the malaria attack rate between SR- and placebo-treated homes was significant when not accounting for the effects of clustering. When the analysis was adjusted for intra-cluster correlation, the differences between SR- and placebo-treated homes were not statistically significant. The findings provide evidence of SR public health benefit and support a larger trial statistically powered to detect those effects.

Author Notes

* Address correspondence to Din Syafruddin, Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta 10430, Indonesia. E-mail: din@eijkman.go.id

Financial support: This study was funded by an award from the Bill & Melinda Gates Foundation (BMGF) to ALERTAsia Foundation in Jakarta on behalf of the Hasanuddin University and Eijkman Institute for Molecular Biology. We express our gratitude to both Foundations for their generosity and vigorous support of this endeavor, especially Kate Aultman at the BMGF, and to Claudia Surjadjaja, Shanti Gayatri, and Manihar Panjaitan. We are deeply grateful to Daniel Lawson and Maude Maier of the S.C. Johnson and Son, Corp., USA for providing the mosquito coils and for expert assistance in the study design. JKB is supported by the Wellcome Trust (grant No. B9RJIXO).

Authors' addresses: Din Syafruddin, Eijkman Institute for Molecular Biology, Jakarta, Indonesia, and Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia, E-mail: din@eijkman.go.id. Michael J. Bangs, Public Health and Malaria Control, International SOS, Kuala Kencana, Papua Indonesia, E-mail: bang_michael@fmi.com. Dian Sidik, Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia, E-mail: dian_sidiq@yahoo.com. Iqbal Elyazar and Siti Nurleila, Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia, E-mails: iqbal.elyazar@gmail.com and snurleila@eocru.org. Puji BS Asih, Krisin Chan, and Christian Nixon, Eijkman Institute for Molecular Biology, Jakarta, Indonesia, E-mails: puji@eijkman.go.id, sanariliskris@yahoo.com, and cnixon@lifespan.org. Joko Hendarto, Isra Wahid, and Hasanuddin Ishak, Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia, E-mails: jokohendarto@gmail.com, israwahid@gmail.com, and hasanuddin.ishak@gmail.com. Claus Bøgh, The Sumba Foundation, Bali, Indonesia, E-mail: cbogh@cbn.net.id. John P. Grieco, Department of Preventive Medicine and Biometrics, Uniformed Services, University of the Health Sciences, Bethesda, MD, E-mail: jgrieco@usuhs.mil. Nicole L. Achee, Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, E-mail: nachee@nd.edu. J. Kevin Baird, Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia, and Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK, E-mail: jkevinbaird@yahoo.com.

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