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The Economic Impact of Screening Rural Houses as an Additional Vector Control against Malaria Transmission in Zambia
Last registered on May 06, 2020

Pre-Trial

Trial Information
General Information
Title
The Economic Impact of Screening Rural Houses as an Additional Vector Control against Malaria Transmission in Zambia
RCT ID
AEARCTR-0005809
Initial registration date
May 06, 2020
Last updated
May 06, 2020 10:24 AM EDT
Location(s)
Primary Investigator
Affiliation
Wageningen University and Research
Other Primary Investigator(s)
PI Affiliation
Wageningen University and Research
PI Affiliation
International Centre of Insect Physiology and Ecology
Additional Trial Information
Status
On going
Start date
2019-01-03
End date
2022-11-15
Secondary IDs
Abstract
Malaria has been recognized as one of the important health concerns in developing countries, with dire economic consequences particularly in Sub-Sahara Africa. In Zambia, the disease accounted for 2000 deaths in 2016 while its prevalence among children under the age of 5 is as estimated to be as high as 30 percent in some rural parts of the country. In this study we seek to determine the socio-economic impacts of House Screening (HS), a malaria control intervention, which works by covering windows, doors and eaves of rural houses with wire mesh, thus protecting the entire households from mosquito bites. We also explores how to stimulate appropriate household behaviors using loss aversion and knowledge diffusion in order to optimize the outcomes of HS. There are several channels through which malaria impedes economic development. Apart from the immediate debilitating effects of morbidity and mortality, it imposes negative impacts on human capital including low productivity, low income and low educational attainment. Therefore, a study to determine the socio-economic impact of HS is necessary for understanding the full-scale impact of interventions that control malaria such as HS. Furthermore, understanding the cost effectiveness of the house screening intervention as well as the Cost Benefit Analysis (CBA) is essential for public health investment considerations. Behavior of households can have profound effects on the outcomes of malaria control interventions including HS. Behaviors such as hours residents spend indoors and outdoors at night have been considered as important in previous studies. Similarly, behaviors such as closing of doors, windows and maintenance of the house screens may have affects on the outcomes of the HS intervention. Using incentives to stimulate appropriate behavior has been studied in several domains. Incentives and nudges can significantly influence behavior to produce desired outcomes. Particularly, framing of incentives as losses has been observed to produce larger positive effects compared to gains - suggesting that the loss frame motivates behavior to a greater extent than the gain frame does. Furthermore, social networks have been identified as important channels for knowledge diffusion. Hence, diffusion of knowledge about house screening is likely to take place within social networks and this may affect their knowledge, behavior towards malaria prevention and willingness to pay for the technology among those who have not yet received it. This study contributes to the emerging literature on the impact of HS, loss aversion and social networks with potential application to health policies in developing countries
External Link(s)
Registration Citation
Citation
Bulte, Erwin, Brian Chisanga and Menale Kassie. 2020. "The Economic Impact of Screening Rural Houses as an Additional Vector Control against Malaria Transmission in Zambia." AEA RCT Registry. May 06. https://doi.org/10.1257/rct.5809-1.0.
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Experimental Details
Interventions
Intervention(s)
The main intervention is house screening which protects entire households against mosquito entry thereby reducing or eliminating mosquito bites and malaria cases. The method involves covering windows, doors and eaves of houses with wire mesh with spaces small enough to prevent the entry of mosquitoes. Treatment households will receive house screens plus a mosquito net also referred to as Long Lasting Insecticide Treated Nets (LLINs), while control households will not receive house screens, however, they will each receive a mosquito net. A sub-intervention is the provision of community mobilisation in selected villages, which will provide awareness information on house screening.
Intervention Start Date
2019-12-02
Intervention End Date
2021-05-31
Primary Outcomes
Primary Outcomes (end points)
• Number of days children were sick with malaria
• Number of days adults were sick with malaria
• Disability Adjusted Life Years (DALYs)
• Total number of days missed work due to malaria
• Number of school days absent due to malaria
• Household income
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
• Hours spent indoors at night
• Hours spent outdoors at night
• Doors kept closed (%)
• windows kept closed (%)
• Noticed breakages or spaces on screens (%)
• Repaired /maintained screens (%)
• Sleeping under a mosquito net (%)
• Knowledge score on house screening
• Knowledge score on malaria prevention behaviour
• Willing to adopt house screening
• Willing to pay for house screening
• Willingness to pay bid amount
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
The impact evaluation will take place in Nyimba District in the Eastern Province of Zambia. The main treatment is house screening (Treatment 0), which involves free provision and installation of house screens to treatment households plus a mosquito net. The control households will not receive house screens, however, they will each receive a mosquito net. Treatment will be randomly assigned to 400 households while 400 will be control households. Random assignment will be blocked by rural and urban blocks. The rural/urban block is defined by the distance to the urban center (and urban clinic) -with the rural block being further than the urban. Thus, equal samples will be assigned to the treatment and control groups from each of the two blocks. Community mobilization, will be a sub-treatment (Treatment 1), which involves the creation of awareness on house screening to be assigned to selected villages. A total of 45 villages will be randomly assigned to treatment while 44 will be control villages. To test the loss aversion nudge, 200 households from the treatment group (with house screening) will be randomly assigned to the gain frame (Treatment 2) while the other 200 will be assigned the loss frame (Treatment 3). The study will establish social network links between the treated and control households by exploring distance and friendship ties with the help of a household survey and GIS mapping. Treatment 4 is connectedness of the household. Control households with at least one social network with the treated households are the connected households while those without any networks are the unconnected households.
Experimental Design Details
Not available
Randomization Method
Randomization will be done in an office on a computer i.e. the main random allocation to treatment (400 households) and control (400 households).
Randomization Unit
The randomisation unit is the household except for the community mobilisation treatment which will be at village level
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
80 villages
Sample size: planned number of observations
800 households
Sample size (or number of clusters) by treatment arms
400 treated households; 400 control households
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials

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IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
IRB Approval Date
IRB Approval Number