Project Details

Permethrin-treated baby wraps for the prevention of malaria in refugee settings

Ross Boyce, MD, MSc

Summary

BACKGROUND: Many populations that experience a high burden of malaria - namely those displaced by conflict or natural disasters – do not have access to bed nets. Furthermore, there is growing evidence that malaria vectors are increasingly biting outside the home and during dawn and dusk periods, thereby limiting the protection offered by bed nets, even when available. GAP: Recent innovations in malaria control are unlikely to benefit populations displaced by conflict and natural disasters, estimated at more than 35 million in Africa alone. New tools to protect the most vulnerable (i.e., young children) are needed. HYPOTHESIS: Our hypothesis is that permethrin-treated baby wraps deter mosquito biting and protect against malaria, particularly in settings where other interventions are not available. METHODS: We will conduct a double blind, randomized, placebo-controlled trial in the Kyangwali Refugee Settlement of Uganda. Recently arrived mother-infant pairs will be randomized in a 1:1:1 ratio between (i) wraps soaked in 0.5% permethrin, (ii) factory-treated permethrin wraps and (iii) untreated wraps (control arm). Participants will attend monthly clinic visits for 6 months. The primary outcome will be clinical malaria in children, defined as fever and a positive malaria RDT. RESULTS: Pending. IMPACT: If our hypotheses are correct, the results of this trial will provide rigorous and compelling evidence for immediate implementation of permethrin-treated wraps in refugee settings. Given that 80% of refugees are women and children, the potential impact – frequently lifesaving – may be substantial. Website Link: https://www.med.unc.edu/medicine/infdis/people/ross-boyce-md-msc/Optional/Additional Comments: Links to recent media coverage. https://www.nytimes.com/2025/10/25/health/insecticide-treated-baby-wraps-carriers-malaria.html https://www.theguardian.com/global-development/2026/jan/16/cloth-wraps-treated-with-insecticide-cut-malaria-cases-in-babies