Permethrin-treated chaddars and top-sheets: appropriate technology for protection against malaria in Afghanistan and other complex emergencies

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene 1999-09, Vol.93 (5), p.465-472
• Main Authors: Rowland, Mark, Durrani, Naeem, Hewitt, Sean, Mohammed, Nasir, Bouma, Menno, Carneiro, Ilona, Rozendaal, Jan, Schapira, Allan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Afghanistan; Afghanistan - ethnology; Aged; Animals; Anopheles; Biological and medical sciences; Child; Child, Preschool; complex emergencies; Culicidae; Female; Fundamental and applied biological sciences. Psychology; Health Surveys; Humans; Infant; Infant, Newborn; insecticide-treated materials; Insecticides - administration & dosage; Insecticides - economics; Logistic Models; malaria; Malaria - economics; Malaria - ethnology; Malaria - prevention & control; malaria control; Malaria, Falciparum - economics; Malaria, Falciparum - ethnology; Malaria, Falciparum - prevention & control; Malaria, Vivax - economics; Malaria, Vivax - ethnology; Malaria, Vivax - prevention & control; Male; Medically important nuisances and vectors, pests of stored products and materials: population survey and control; Middle Aged; Mosquito Control - economics; Mosquito Control - methods; mosquitoes; Pakistan; Pakistan - epidemiology; Permethrin; Pyrethrins - administration & dosage; Pyrethrins - economics; Refugees; Risk Factors; Tropical medicine; Vectors. Intermediate hosts
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1016/S0035-9203(99)90341-3

Insecticide-treated mosquito nets (ITN) provide excellent protection against malaria; however, they have a number of shortcomings that are particularly evident in politically unstable countries or countries at war: not everyone at risk can necessarily afford a net, nets may be difficult to obtain or import, nets may not be suitable for migrants or refugees sleeping under tents or plastic shelter. There is a need to develop cheaper, locally appropriate alternatives for the most impoverished and for victims of complex emergencies. Afghan women, in common with many Muslim peoples of Asia, wear a veil or wrap known as a chaddar to cover the head and upper body. This cloth doubles as a sheet at night, when they are used by both sexes. A randomized controlled trial was undertaken in which 10% of the families of an Afghan refugee camp (population 3950) in north-western Pakistan had their chaddars and top-sheets treated with permethrin insecticide at a dosage of 1 g/m2 while a further 10% had their chaddars treated with placebo formulation. Malaria episodes were recorded by passive case detection at the camp's health centre. From August to November the odds of having a falciparum or vivax malaria episode were reduced by 64% in children aged 0–10 years and by 38% in refugees aged