Malaria Journal最新文献

{"title":"Contemporary Anopheles vector species distribution in Scotland and its association with historical hotspots of malaria transmission.","authors":"Kieran Killen, Georgia Kirby, Rebecca Brown, Susanne Krabbendam, Luca Nelli, Heather M Ferguson","doi":"10.1186/s12936-026-06061-1","DOIUrl":"10.1186/s12936-026-06061-1","url":null,"abstract":"<p><strong>Background: </strong>Malaria poses a significant threat to public health in tropical regions, with nearly half of the global population at risk. Historically, transmission was common in temperate regions including northwestern Europe, with records indicating that malaria was prevalent in Scotland until the early nineteenth century. While current environmental and epidemiological conditions are unsuitable for transmission, future climate, environmental, and land-use change may alter the receptivity of Scotland to malaria and other mosquito-borne diseases. As a first step to assess the potential for future transmission risk, we aimed to map the distribution of two native Anopheles mosquito species in Scotland that have been implicated in historical malaria transmission and assess the relationship between areas of high contemporary suitability and historical hotspots of transmission.</p><p><strong>Methods: </strong>Using data generated from a recent Scotland-wide mosquito surveillance programme and citizen science reporting (2023-2024), we used species distribution models to predict the current distribution of Anopheles claviger and An. plumbeus in Scotland and identify their associations with environmental and land-use variables. Another historical vector, An. maculipennis s.l., was also recorded but with too few observations for reliable modelling. Using georeferenced historical parish hotspots of malaria in Scotland (eighteenth century records), we tested whether predicted contemporary suitability at hotspot locations was higher than expected by chance using comparisons against randomly sampled background locations.</p><p><strong>Results: </strong>Several climatic and physical environmental variables were associated with Anopheles species distribution in Scotland, with altitude and landcover being the most consistent, and temperature and precipitation having variable impact across species. Anopheles were predicted to have widespread distribution across coastal and lowland Scotland, with pockets of habitat suitability extending up to the northeast coast and Shetland islands. Historical hotspots of malaria (parish locations) were consistently associated with higher predicted current suitability for Anopheles species than background locations.</p><p><strong>Conclusions: </strong>Overall, these findings show that potential malaria vectors are still common throughout Scotland and highlight the need for continued monitoring to generate more accurate estimates of predictors, distribution and future disease risk.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining safety parameters for first-trimester malaria treatment trials: stakeholder views from Real-Time Delphi survey.","authors":"Sandra Bivegete, Hellen Barsosio, Myriam El Gaaloul, Kassoum Kayentao, Eve Worrall, Stephan Duparc, Wiweka Kaszubska, Innocent Valea, Jenny Hill, Feiko Ter Kuile, Stephanie Dellicour","doi":"10.1186/s12936-026-06045-1","DOIUrl":"10.1186/s12936-026-06045-1","url":null,"abstract":"<p><strong>Background: </strong>In 2022, the World Health Organisation recommended artemether-lumefantrine as the first-line treatment for uncomplicated malaria in first-trimester pregnancy. However, emerging drug resistance and WHO's recommendation for treatment diversification necessitate research on alternative artemisinin-based combination therapies (ACTs). We conducted a Real-Time (RT) Delphi survey to establish stakeholder views on safety endpoints and non-inferiority margins for a randomised controlled trial evaluating ACTs in first-trimester pregnancy.</p><p><strong>Methods: </strong>An international RT Delphi study was conducted between September and October 2024, including clinical researchers, regulators, policymakers, ethicists, and healthcare practitioners. Stakeholders completed an online survey, rating the importance of composite endpoints and maternal and infant safety-related outcomes on a 5-point Likert scale. Outcomes were ranked, and acceptable non-inferiority safety margin were explored. Quantitative responses were summarised descriptively, and free-text comments were analysed thematically.</p><p><strong>Results: </strong>Of the 54 stakeholders invited, 30 responded (56%). Most (23/30, 77%) agreed that a composite safety endpoint consisting of miscarriage, stillbirth, and major congenital anomalies was informative for evaluating ACT safety in the first trimester. Maternal outcomes rated as critical included maternal death (27/30, 90%), severe maternal anaemia (23/30, 77%), renal failure (20/30, 67%), and maternal intensive care admission (19/29, 66%). For infant outcomes, major congenital anomalies (28/30, 94%), stillbirth (26/30, 87%), and neonatal death (25/30, 83%) were considered essential. Most respondents endorsed a non-inferiority margin of HR = 1.2 as a pragmatic balance between trial feasibility and acceptable uncertainty around safety. Qualitative analysis highlighted support for the composite endpoint to address competing risks. However, concerns were raised regarding the non-specificity of some outcomes, such as preterm birth and small-for-gestational-age, which may be influenced by factors unrelated to treatment.</p><p><strong>Conclusions: </strong>This study provides a framework for researchers to determine key safety outcomes and acceptable non-inferiority margins for malaria treatment trials in the first trimester. Incorporating stakeholder perspectives into trial design can support evidence-informed policy and facilitate the deployment of a wider range of antimalarial treatments considered safe in early pregnancy.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond national household surveys: routine and alternative approaches to sustain robust evidence-based decision making.","authors":"Alicia Nizet, Hannah Margaret Edwards, Afredo Mayor, Sol Richardson, Stephen Poyer, Gillian Stresman, Elizabeth Burrough, Cyril Ademu, Molly Robertson, Arantxa Roca-Feltrer","doi":"10.1186/s12936-026-06044-2","DOIUrl":"10.1186/s12936-026-06044-2","url":null,"abstract":"<p><p>Robust, timely, and decision-oriented surveillance, monitoring, and evaluation (SM&E) systems are fundamental to malaria control and elimination. National household surveys such as the Demographic and Health Surveys (DHS), Malaria Indicator Surveys (MIS), and Multiple Indicator Cluster Surveys (MICS) have historically provided high quality, comparable estimates of malaria burden and intervention coverage. However, substantial recent reductions in global malaria financing have led many endemic countries to delay, scale back, or cancel these surveys, resulting in widening evidence gaps. This perspective paper discusses how malaria programs can adapt by employing a broader set of SM&E approaches. We summarized the use-cases and key considerations of several alternative methodologies, including routine health facility surveillance, first antenatal care visit (ANC1) surveillance, sentinel surveillance systems, Lot Quality Assurance Sampling (LQAS), and targeted cross-sectional surveys, and described how these approaches can reduce reliance on large-scale surveys. While each method has its strengths and limitations, their usefulness depends on the primary SM&E objective, as well as assessing feasibility and data quality, and accounting for transmission setting and representativeness. Routine surveillance remains the central platform for malaria SM&E and should be strengthened to provide quality, continuous, geographically granular insights. Alternative methodologies can add value by validating trends, capturing asymptomatic or non-care seeking infections, or enabling rapid classification against program thresholds where timely decisions are required. To support transparent and context-appropriate method selection, a multidisciplinary taskforce under the Roll Back Malaria Partnership's (RBM) SM&E Working Group developed the SM&E Decision-Support Tool. This tool translates expert consensus and a targeted evidence review into a practical decision tree that aligns methodological options with stated objectives, data availability, and implementation context. It is designed to guide SM&E planning discussions rather than replace feasibility assessments. In conclusion, malaria programs should invest in strengthening routine surveillance systems while adopting a broader, fit-for-purpose portfolio of complementary methodologies tailored to specific decision needs. Further comparative work on costs, feasibility, data quality, and precision levels across settings is needed. Building a stronger evidence base for method selection will help ensure that SM&E strategies remain transparent, appropriate, and sustainable under resource constraints.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying populations with high prevalence of non-malarial febrile illnesses across different demographic groups in Malawi.","authors":"Peter Austin Morton Ntenda, David Matiya, Precious Kondwani Majoni, Rex Barnett Mbewe, Fentanesh Nibret Tiruneh","doi":"10.1186/s12936-026-06058-w","DOIUrl":"10.1186/s12936-026-06058-w","url":null,"abstract":"<p><strong>Background: </strong>Malaria remains a major cause of febrile illness in Malawi; however, the epidemiology of non-malarial febrile illnesses (NMFIs) is less well characterized. Understanding the distribution and determinants of NMFIs across demographic groups is essential for improving case management in malaria-endemic settings.</p><p><strong>Objectives: </strong>This study aimed to characterized the distribution and predictors of NMFIs among preschool-aged children (PSC), school-aged children (SAC), women of reproductive age (WRA), and men in Malawi.</p><p><strong>Methods: </strong>Secondary data from the 2015-2016 Malawi Micronutrient Survey were analyzed. Multivariable logistic regression models were fitted separately for each population subgroup to identify factors independently associated with NMFIs. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported.</p><p><strong>Results: </strong>The prevalence of NMFIs was highest among PSC (27.0%) and lowest among men (9.1%). Asymptomatic malaria was most common in SAC (28.6%), while symptomatic malaria was highest in PSC (15.9%). Among PSC, age 24-35 months (aOR = 2.5; 95% CI 1.4-4.6), recent diarrhea (aOR = 1.6; 95% CI 1.1-2.5), recent cough (aOR = 3.8; 95% CI 2.5-5.7), wasting (aOR = 2.2; 95% CI 1.0-4.8), and urban residence (aOR = 1.9; 95% CI 1.0-3.5) were associated with increased odds of NMFIs. In SAC, WRA, and men, recent cough was a consistent predictor of NMFIs (aOR = 1.9; 95% CI 0.9-4.2; aOR = 3.1; 95% CI 1.7-5.8; and aOR = 44.3; 95% CI 10.2-192.8, respectively). Among WRA and men, elevated alpha-1-acid glycoprotein levels were also associated with higher odds of NMFIs (aOR = 2.2; 95% CI 1.0-4.8 and aOR = 4.5; 95% CI 1.0-86.4, respectively).</p><p><strong>Conclusion: </strong>PSC bear the highest burden of NMFIs and symptomatic malaria, while SAC commonly harbor asymptomatic malaria. Febrile illness management should move beyond malaria-focused approaches to include integrated screening for common non-malarial infections, particularly in young children.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of malaria infection from parasite-free blood smears.","authors":"Nicolas Bourriez, Saranga Kingkor Mahanta, Ivan Svatko, Eleanor Lacassagne, Aurore Atchade, Francesco Leonardi, Ethan Cohen, Achille Massougbodji, Nicolas Argy, Gilles Cottrell, Auguste Genovesio","doi":"10.1186/s12936-026-06047-z","DOIUrl":"10.1186/s12936-026-06047-z","url":null,"abstract":"<p><p>Malaria affects almost 263 million people worldwide, most of whom live in sub-Saharan countries. In a strategy to reduce malaria-related mortality and limit transmission, diagnosis in endemic areas needs to be immediately available on the field, easy to perform and cheap. Therefore, it currently heavily relies on microscopic examination of blood smears. However, several studies comparing the sensitivity of this approach with qPCR, considered as the most sensitive method albeit not available on the field, found that up to half of the infected population failed to be detected by microscopy alone because no visible parasites could be found in blood smears. These so-called submicroscopic infections pose a diagnostic challenge, yet represent a huge reservoir for malaria transmission. In this study, we hypothesized that qPCR results could be predicted by deep learning from subtle cell signals present in thin blood smear images, even in the absence of visible parasites, making a sensitive diagnostic directly available on the field using a microscope and a smartphone. To test this hypothesis, we acquired a large smartphone-based blood smear images dataset from samples tested both for microscopy and qPCR. We then focused exclusively on these \"negative\" slides from the microscopic diagnostic point of view, among which half were qPCR positive. A range of standard deep learning models were evaluated to best predict the qPCR result from these microscopy images, using various backbones along with various aggregation functions at the slide level, from a simple vote to Multiple Instance Learning with attention. Our results show that the qPCR results can be predicted from parasite free blood smear images with 62.0% (± 2.5 on 4-folds) accuracy and reaching 67.2% (± 9.6 on 4-folds) in sensitivity. We then used generative models to investigate the subtle morphological variations occurring in red blood cells that may contribute to predicting malaria infection in the absence of parasites. Leveraging thin blood smear and portable deep learning, we established the first proof of concept that the qPCR sensitivity can be approached through the detection of submicroscopic infections directly on the field without additional infrastructure and thus could significantly improve malaria surveillance and elimination efforts.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelling geographical variation in the determinants of childhood malaria in Malawi using geographically weighted regression.","authors":"Mary Magoya, Samuel Manda, Bedilu Ejigu","doi":"10.1186/s12936-026-06036-2","DOIUrl":"10.1186/s12936-026-06036-2","url":null,"abstract":"<p><p>Malaria remains a leading cause of morbidity and mortality among children in Malawi with transmission exhibiting marked geographic disparities. While standard regression models estimate the association between childhood malaria and risk factors across the entire study area, they assume spatial stationarity, thereby masking local-area variations in estimated effects. We applied Geographically Weighted Regression, a spatial non-stationarity modeling approach to data from the recent 2024 Malawi Demographic and Health Survey to estimate district-specific associations between childhood malaria and selected risk factors, namely mosquito net use, place of residence, household wealth, maternal age, and maternal education. The overall malaria prevalence among children aged five or under was 36.3%. By applying Geographically Weighted Regression, the study demonstrated substantial spatial heterogeneity in the associations between childhood malaria and the selected predictors across Malawi, revealing locally varying effects that would have been obscured under conventional global modelling approaches. These findings highlight the value of locally estimated relationships for understanding contextual differences in the predictors of childhood malaria and provide district-specific evidence to support geographically targeted intervention strategies and more efficient allocation of prevention and treatment resources within Malawi's National Malaria Control Programme.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating routinely collected mosquito vector and human behavioral data for malaria prevention: A case example in central region Malawi.","authors":"Kaci D McCoy, Allison Hendershot, Abdoulaye Bangoura, Leonard Dandalo, Michael Bride, Shadreck Mulenga, Akuzike Banda, John Munthali, Themba Mzilahowa, Sophia Kaufman, Stella Babalola, Shelby Cash, John E Gimnig, Gabrielle Hunter, Bolanle Olapeju, Joseph Millward, Neil F Lobo, Sarah Zohdy, Jenny Carlson Donnelly, April Monroe","doi":"10.1186/s12936-026-06043-3","DOIUrl":"10.1186/s12936-026-06043-3","url":null,"abstract":"<p><strong>Background: </strong>Integrating human behavioral data with data on malaria vector biting rates can help to quantify human exposure to malaria vectors and identify gaps in protection; however, to date, the availability of necessary human location and behavior data have been more limited as compared to that of corresponding entomological data. To expand the data available for use in vector-human data integrations, this case example explored the process and interpretations of integrating human behavior estimates from the Malaria Behavior Survey (MBS), a large-scale cross-sectional survey measuring behaviors and their determinants, with routinely collected VectorLink entomological surveillance data in Central Malawi.</p><p><strong>Methods: </strong>This study followed established guidance on vector-human data integration to guide extraction of necessary data inputs from existing, routinely collected data. Hourly nighttime human behavior and location estimates, as well as population insecticide treated bednet (ITN) use rate, were derived from questions in the Malawi MBS, conducted in Malawi in May-July 2021. Hourly nighttime human biting rates were derived from human landing catches (HLCs) carried out by VectorLink in Malawi in June 2021. Human and vector data were then integrated to provide weighted estimates of exposure to vector bites, accounting for proportions of people indoors or outdoors, and protected by ITNs, each hour of the night.</p><p><strong>Results: </strong>When accounting for mosquito and human location, most exposure to vector bites was estimated to occur indoors (96%), at times when people were asleep (87%). Although most mosquito bites occurred indoors during sleeping hours-when ITNs could offer protection-only 35% of all exposure to bites was estimated to be prevented, considering that the population-level usage rate of ITNs was only 40%. ITN access, which was only 39%, was identified as an important factor contributing to the protection gap.</p><p><strong>Conclusion: </strong>This case example suggests that integrating routinely collected entomological and human behavioral data can provide programmatically relevant insights. Future studies or programs may consider data integration of similar sources to better inform vector control or social and behavior change activities.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local implementation of scalable malaria molecular surveillance in a low-resource setting: a North-South collaborative model.","authors":"Martin Lukindu, Edward Lukyamuzi, Faisal Ashraf, Sanjay C Nagi, Alfred Ssekagiri, Trevor Mugoya, Calvin Yee, Solome Mukwaya, Eric Lucas, Tony Nolan, Martin Donnelly, Jonathan Kayondo","doi":"10.1186/s12936-026-06040-6","DOIUrl":"10.1186/s12936-026-06040-6","url":null,"abstract":"<p><p>Molecular surveillance of malaria vectors remains critically underutilized in sub-Saharan Africa, largely due to limited human capacity and technical resources, despite the region bearing the highest global burden of malaria. In a North-South collaborative effort, Uganda Virus Research Institute (UVRI) and Liverpool School of Tropical Medicine (LSTM) built capacity and improved on existing computational capabilities in line with molecular surveillance of Anopheles gambiae, the primary malaria vector in sub-Saharan Africa. We interrogated an amplicon panel capable of simultaneously detecting 55 Insecticide Resistance markers and 35 Ancestral Informative Markers, as well as polymorphisms in the doublesex gene-a key target for homing-based gene drives aimed at suppressing malaria vector populations. This represents a substantial advancement over conventional surveillance tools. The panel was tested and locally validated at UVRI with the lab colony and wild populations and a versatile data analysis pipeline for the panel was designed for raw data processing, analysis, and visualization. The tools and experience from this collaborative effort enhance molecular vector surveillance in the region and beyond, while also acting as a template for similar collaborations by other institutions.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Entomological Adaptive Sampling Framework (EASF) for malaria vector surveillance: an economic evaluation of pilot implementation in Ghana and Mozambique.","authors":"Anton L V Avanceña, Nicholas W Daniel, Mercy Opiyo, Steven Gowelo, Allison Tatarsky, Luis Jamu, Dulcisária Marrenjo, Samuel K Oppong, Ernest Boampong, Christian Atta-Obeng, Otubea Owusu-Akrofi, Keziah Laurencia Malm, Neil Lobo, Edward Thomsen","doi":"10.1186/s12936-026-06020-w","DOIUrl":"10.1186/s12936-026-06020-w","url":null,"abstract":"<p><strong>Background: </strong>Entomological surveillance provides critical information for National Malaria Programs (NMPs), yet there is limited evidence on the cost-effectiveness of alternative sampling approaches. Conventional surveillance often relies on purposive, fixed-site sampling, which may produce biased or non-representative data. To address these limitations, the Entomological Adaptive Sampling Framework (EASF) was developed to optimize sampling strategies based on spatiotemporal vector dynamics. This study evaluates the costs and cost-effectiveness of EASF compared to routine entomological surveillance in Ghana and Mozambique.</p><p><strong>Methods: </strong>We conducted a cost and cost-effectiveness analysis of EASF using prospective data from pilot implementations in Ghana (July 2023-2024) and Mozambique (September 2022-August 2024). Costs (in current US$) were estimated from a payer perspective through microcosting , categorized by input type and activity. Effectiveness was measured based on collection yields, namely the total number of mosquitoes collected and the average number of mosquitoes per collection. Incremental cost-effectiveness ratios (ICERs) were calculated to compare EASF with routine entomological surveillance.</p><p><strong>Results: </strong>The total costs of EASF were $144,688 in Ghana (13 months) and $48,646 in Mozambique (9 months). EASF was associated with higher costs than routine surveillance ($90,004 in Ghana; $22,311 in Mozambique). On average, EASF was associated with 0.75 and 1.12 more mosquitoes per collection in Ghana and Mozambique, respectively. The unit cost of each mosquito collected was lower under EASF ($11.10 vs. $43.65 in Ghana; $54.23 vs. $743.69 in Mozambique). The ICERs of EASF were $4.98 and $30.38 per additional mosquito collected, and $30.23 and $72.76 per increase in the average number of mosquitoes per collection in Ghana and Mozambique, respectively.</p><p><strong>Conclusions: </strong>EASF has the potential to improve the efficiency of entomological surveillance by collecting more mosquitoes at lower costs. Future research should build on these findings by demonstrating the downstream value of improved entomological data on NMP decision-making and malaria transmission. A budget impact analysis should assess the affordability of scaling up EASF.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multi-country non-inferiority experimental hut evaluation of DuraNet^® Plus, an alpha-cypermethrin and piperonyl butoxide treated net, for control of pyrethroid-resistant malaria vectors in West and Central Africa.","authors":"Abel Agbevo, Judicael Nounagnon, Benjamin Menze, Ludovic P Ahoua Alou, Achille Binyang, Boris N'dombidje, Charles Wondji, Raphael N'Guessan, Corine Ngufor","doi":"10.1186/s12936-026-06039-z","DOIUrl":"10.1186/s12936-026-06039-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pyrethroid-piperonyl butoxide (PBO) nets enhance malaria vector control by counteracting metabolic resistance mechanisms in malaria vectors through the synergistic action of PBO. DuraNet&lt;sup&gt;®&lt;/sup&gt; Plus is an alpha-cypermethrin and PBO incorporated net developed Shobikaa Impex Private Limited. This study assessed its entomological efficacy relative to a standard pyrethroid-only net (DuraNet&lt;sup&gt;®&lt;/sup&gt;) and an established pyrethroid-PBO net (Olyset&lt;sup&gt;®&lt;/sup&gt; Plus), in support of WHO prequalification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Experimental hut trials were conducted at three ecologically and entomologically distinct sites with pyrethroid-resistant vector populations: Covè, Benin (Anopheles gambiae s.l.), Mibellon, Cameroon (An. funestus), and M'bé, Côte d'Ivoire (An. gambiae s.l.). Each net type was tested unwashed and after 20 standardized washes. Primary outcomes included 24-h mosquito mortality and blood-feeding inhibition. DuraNet&lt;sup&gt;®&lt;/sup&gt; Plus was evaluated for non-inferiority to Olyset&lt;sup&gt;®&lt;/sup&gt; Plus and superiority over DuraNet&lt;sup&gt;®&lt;/sup&gt; using combined washed and unwashed data, in line with WHO guidelines. WHO bioassays confirmed pyrethroid resistance and assessed the role of cytochrome P450 enzymes. Chemical analyses measured pyrethroid and PBO retention after washing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;DuraNet&lt;sup&gt;®&lt;/sup&gt; Plus induced higher mosquito mortality than Olyset&lt;sup&gt;®&lt;/sup&gt; Plus across all sites (Benin: 29.5% vs. 14.9%, OR = 2.81, 95% CI 2.34-3.38, NIM = 0.468; Cameroon: 27.8% vs. 22.2%, OR = 1.81, 95% CI 1.32-2.49, NIM = 0.62; Côte d'Ivoire: 19.5 vs. 12.0%, OR = 2.28, 95% CI 1.85-2.80, NIM = 0.37), with all odds ratios exceeding the WHO-defined non-inferiority margins. DuraNet&lt;sup&gt;®&lt;/sup&gt; Plus also met non-inferiority criteria for blood-feeding inhibition compared to Olyset&lt;sup&gt;®&lt;/sup&gt; Plus (Benin: OR = 0.23, 95% CI 0.18-0.28, NIM = 1.345; Cameroon: OR = 0.66, 95% CI 0.50-0.87, NIM = 1.32; Côte d'Ivoire: OR = 0.58, 95% CI 0.48-0.69, NIM = 1.40). In addition, DuraNet&lt;sup&gt;®&lt;/sup&gt; Plus was superior to DuraNet&lt;sup&gt;®&lt;/sup&gt; in both mosquito mortality and blood-feeding inhibition across all study sites (p &lt; 0.05). Susceptibility bioassays confirmed high frequencies of pyrethroid resistance across all three sites, with varying levels of P450 enzyme involvement. Chemical analysis showed higher retention of alpha-cypermethrin and PBO in DuraNet&lt;sup&gt;®&lt;/sup&gt; Plus after 20 washes compared with the permethrin and PBO content in Olyset&lt;sup&gt;®&lt;/sup&gt; Plus.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;DuraNet&lt;sup&gt;®&lt;/sup&gt; Plus showed strong entomological efficacy and wash durability against pyrethroid-resistant malaria vectors across varied settings in West and Central Africa. It met WHO non-inferiority criteria compared to Olyset&lt;sup&gt;®&lt;/sup&gt; Plus and was superior to a pyrethroid-only ITN, supporting its inclusion among WHO-prequalified products. These findings underscore its potential role in vector control strat","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}