Next-Generation Bed Nets to Control Malaria in Côte d'Ivoire
In brief
Chlorfenapyr-treated nets cut childhood malaria incidence by 43% in Côte d'Ivoire
In a cluster-randomized trial, children aged 6 months to 9 years had 0.65 malaria cases per child-year with chlorfenapyr-pyrethroid nets, versus 1.11 with standard pyrethroid-only nets - a 43% lower incidence over 12 months. Piperonyl butoxide-pyrethroid nets also reduced incidence, by 28%; how long these benefits last beyond a year remains unknown.
- Journal
- NEJM evidence (Q1)
- Published
- 27 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Colette Sih, Serge B Assi, Edouard Dangbenon, Alphonsine A Koffi, Ludovic P Ahoua Alou, Soromane Camara, et al.
- PMID
- 42937427
- DOI
- 10.1056/EVIDoa2600153
Why clinicians should know about it
- Picked for Pediatrics and Child Health (paper of the day, 28 October 2026): Cluster RCT reduced malaria incidence in children
Abstract
BACKGROUND: Next-generation long-lasting insecticidal nets (LLINs) treated with more than one insecticide have been insufficiently evaluated in West Africa. METHODS: In this cluster randomized clinical trial, 33 clusters of villages (1-3 villages per cluster) in Côte d'Ivoire were randomly assigned (11 clusters per group) to use pyrethroid-only (py-only; MAGNet) (control), piperonyl butoxide-pyrethroid (PBO-py; Veeralin), or chlorfenapyr-pyrethroid (CFP-py; Interceptor G2) LLINs. One net was distributed for every two people, followed by door-to-door visits to assist with hanging the nets and to promote their use. The primary outcome was the incidence of malaria cases among children aged 6 months to 9 years over the year following net distribution. Incidence rate ratios compared cases per child-year between clusters randomly assigned to use PBO-py versus py-only nets and CFP-py versus py-only nets. RESULTS: A total of 25,660 LLINs were distributed to 11,283 households (py-only, n=3797; PBO-py, n=3559; and CFP-py, n=3927). The primary outcome analyses included 549, 551, and 549 children in the py-only, PBO-py, and CFP-py groups, respectively. Mean malaria incidence over 12 months was 1.11 cases per child-year in the py-only group (control), 0.84 in the PBO-py group, and 0.65 in the CFP-py group. The incidence rate ratios were as follows: PBO-py versus py-only nets, 0.72 (95% confidence interval [CI], 0.52 to 0.99; P=0.045); and CFP-py versus py-only nets, 0.57 (95% CI, 0.43 to 0.75; P<0.001). CONCLUSIONS: Malaria incidence over 12 months was significantly reduced among children aged 6 months to 9 years residing in clusters of villages in Côte d'Ivoire that were randomly assigned to use CFP-py versus py-only LLINs and PBO-py versus py-only LLINs. (Funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria; ClinicalTrials.gov number, NCT05796193.).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.