Outdoor attractive targeted sugar bait Phase III trials for malaria control in Kenya, Mali, and Zambia: An individual participant data meta-analysis
13 affiliations
- 1Centre for Applied Malaria Research and Evaluation, Celia Scott Weatherhead School of Public Health & Tropical Medicine at Tulane University, New Orleans, Louisiana, United States of America
- 2Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- 3University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
- 4International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- 5Innovative Vector Control Consortium, Liverpool, United Kingdom
- 6Independent Consultant, Washington, District of Columbia, United States of America
- 7Independent Consultant, Lusaka, Zambia
- 8PATH, Washington, District of Columbia, United States of America
- 9Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
- 10Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- 11Malaria Branch, Division of Parasitic Diseases and Malaria, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Kisumu, Kenya
- 12Malaria Branch, Division of Parasitic Diseases and Malaria, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GeorgiaUnited States of America
- 13School of Public Health, Imperial College, London, United Kingdom
Abstract
Attractive targeted sugar baits (ATSB) are a potential new class of vector control tool that act through an “attract and kill” mechanism on mosquitoes. We conducted a meta-analysis using data from three large-scale Phase III trials of the Westham Sarabi v1.2 ATSB (0.11% dinotefuran) conducted in Kenya, Mali, and Zambia, to determine the effect of the intervention on clinical malaria incidence in children, Plasmodium falciparum infection prevalence, and dominant vector species parity, abundance, landing rate, and sporozoite positivity. The Sarabi ATSB was deployed on exterior walls at the rate of two per residential structure. Aggregated and individual-level meta-analyses were completed for each of the six trial outcomes, comprising 6981 person-years of follow-up for clinical malaria incidence (primary epidemiological outcome) and 19443 Anopheles for parity assessment (primary entomological outcome). Post-hoc analyses included assessment of dose-response relationships between coverage-adjusted intervention density and clinical malaria incidence. There were no statistically significant differences between arms in any of the epidemiological or entomological outcomes. There was statistically significant evidence of a 19% reduction in clinical malaria incidence for every 10 bait stations per hectare increase observed in spatial density (IRR 0.81, 95% CI 0.74-0.89, p < 0.001), provided that the ATSB were in good condition. This finding suggests that there may be deployment approaches or dosing strategies under which ATSB tools could be efficacious, although threshold spatial densities could not be determined from available data. This meta-analysis furthermore highlights important recommendations for future cluster-randomized trials of vector control interventions, including conducting comprehensive baseline data collection to identify cluster outliers or sites with differences in vector bionomics, and collecting a limited set of entomological outcomes in all trial clusters to ensure an adequately powered and balanced analysis of entomological effects.
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BibTeX
@article{ashton2026outdoor,
title = {{Outdoor attractive targeted sugar bait Phase III trials for malaria control in Kenya, Mali, and Zambia: An individual participant data meta-analysis}},
author = {Ruth A. Ashton and Daniel P. McDermott and Fousseyni Kane and Sophie Sarrassat and Angela Harris and Christen Fornadel and Joseph Wagman and Javan Chanda and Megan Littrell and Feiko O. ter Kuile and Aaron M. Samuels and Eric Ochomo and Thomas S. Churcher and Joseph Biggs and Sarah G. Staedke and Seydou Doumbia and Immo Kleinschmidt and Joshua Yukich and Thomas P. Eisele},
journal = {PLOS Global Public Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pgph.0006513},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006513},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Outdoor attractive targeted sugar bait Phase III trials for malaria control in Kenya, Mali, and Zambia: An individual participant data meta-analysis
AU - Ruth A. Ashton
AU - Daniel P. McDermott
AU - Fousseyni Kane
AU - Sophie Sarrassat
AU - Angela Harris
AU - Christen Fornadel
AU - Joseph Wagman
AU - Javan Chanda
AU - Megan Littrell
AU - Feiko O. ter Kuile
AU - Aaron M. Samuels
AU - Eric Ochomo
AU - Thomas S. Churcher
AU - Joseph Biggs
AU - Sarah G. Staedke
AU - Seydou Doumbia
AU - Immo Kleinschmidt
AU - Joshua Yukich
AU - Thomas P. Eisele
PY - 2026
DA - 2026/10/09
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0006513
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006513
AB - Attractive targeted sugar baits (ATSB) are a potential new class of vector control tool that act through an “attract and kill” mechanism on mosquitoes. We conducted a meta-analysis using data from three large-scale Phase III trials of the Westham Sarabi v1.2 ATSB (0.11% dinotefuran) conducted in Kenya, Mali, and Zambia, to determine the effect of the intervention on clinical malaria incidence in children, Plasmodium falciparum infection prevalence, and dominant vector species parity, abundance, landing rate, and sporozoite positivity. The Sarabi ATSB was deployed on exterior walls at the rate of two per residential structure. Aggregated and individual-level meta-analyses were completed for each of the six trial outcomes, comprising 6981 person-years of follow-up for clinical malaria incidence (primary epidemiological outcome) and 19443 Anopheles for parity assessment (primary entomological outcome). Post-hoc analyses included assessment of dose-response relationships between coverage-adjusted intervention density and clinical malaria incidence. There were no statistically significant differences between arms in any of the epidemiological or entomological outcomes. There was statistically significant evidence of a 19% reduction in clinical malaria incidence for every 10 bait stations per hectare increase observed in spatial density (IRR 0.81, 95% CI 0.74-0.89, p < 0.001), provided that the ATSB were in good condition. This finding suggests that there may be deployment approaches or dosing strategies under which ATSB tools could be efficacious, although threshold spatial densities could not be determined from available data. This meta-analysis furthermore highlights important recommendations for future cluster-randomized trials of vector control interventions, including conducting comprehensive baseline data collection to identify cluster outliers or sites with differences in vector bionomics, and collecting a limited set of entomological outcomes in all trial clusters to ensure an adequately powered and balanced analysis of entomological effects.
SN - 2767-3375
ER -