EaveTubes for control of vector-borne diseases in Côte d’Ivoire: study protocol for a cluster randomized controlled trial

Vector control tools, particularly long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), have significantly contributed to malaria prevention in sub-Saharan Africa. However, the emergence and spread of insecticide resistance have seriously hampered their efficacy in recent years, making new tools essential to sustain and further progress. In2Care® EaveTubes (ETs) are an inexpensive, new resistance-breaking vector control product under World Health Organization (WHO) evaluation. Informed by mosquito ecology, ETs efficiently target malaria vectors by exploiting their natural entry behavior. By installing ETs in the walls of houses at the eave level, they funnel natural airflow, drawing mosquitoes in through the same heat and odor cues that typically attract them through open eaves. Once inside an ET, mosquitoes are exposed to insecticide-treated netting placed inside the tube. The aim of this study is to test whether ETs as a stand-alone tool have an effect on the epidemiology of malaria in villages where houses have been modified with the ET intervention.

A two-armed, cluster randomized controlled trial will be conducted to evaluate the effect of ETs on clinical malaria incidence in children living in Côte d’Ivoire. Thirty-four villages will be selected based on population size and the proportion of houses suitable for modification with ETs. The villages will be randomly allocated to either the treatment arm (17 clusters: ETs + LLINs) or the control arm (17 clusters: LLINs only). Based on a population census, 55 households per cluster with eligible children (aged between 6 months and 8 years at the start of the study) will be randomly selected for recruitment into active detection cohorts. In the treatment arm, eligible children residing in ET-treated houses will be enrolled. The intervention and control cohorts will be followed for 4 months for baseline covariate measurements and then for 24 months with the intervention in place. During case detection visits, blood samples will be taken from all febrile children and tested for malaria infection using rapid diagnostic tests (RDTs). All positive clinical malaria infections will be treated according to national guidelines. To estimate the impact of ETs on malaria vector densities, entomological measurements will be conducted monthly in 20 clusters (10 ET, 10 control) in 10 randomly selected households per cluster using indoor sampling with CDC traps. To estimate the infectiousness of malaria vectors, sporozoite rates will be measured in subsets of the collected mosquito samples.