Malaria remains a threat to young children in refugee settlements, where displacement, temporary housing, and limited access to health care reduce the effectiveness of traditional prevention measures. There are an estimated 35 million refugees in Africa alone, more than 80% of whom are women and children. New arrivals lack permanent shelter and cannot reliably use mosquito nets, making infants and young children more susceptible to mosquito bites.
Ross Boyce, MD, MS, a researcher in the Institute of Global Health and Infectious Diseases at the UNC School of Medicine, will lead a three-year study in collaboration with partners at Uganda’s Mbarara University of Science and Technology, supported by the Thrasher Research Fund, to evaluate proven malaria prevention strategies tailored to humanitarian settings.
This study will test permethrin-treated baby wrap. This is an innovation that transforms the cultural practice of mothers using cloth wraps to carry their infants on their backs into a barrier against malaria-carrying mosquitoes. This approach is based on strong clinical evidence. In a randomized, placebo-controlled trial conducted in western Uganda, New England Medical Journal (2025), Boyce found that infants carried in permethrin-treated wraps had an approximately 65% reduction in clinical malaria incidence, including the use of bed nets. The results demonstrated meaningful protection beyond netting alone, especially against exposure to mosquitoes outdoors and during the day.
As global funding for humanitarian emergencies dwindles, newly arrived refugees are increasingly forced to build their own shelters. It’s difficult to hang a mosquito net if you don’t have a bed, much less a roof over your head. By building protection into what mothers already use every day, we can reach infants in the moments and places they are most at risk. ”
Dr. Ross Boyce, Associate Professor of Medicine and Epidemiology
Incorporating insect repellents into items that families already use every day means that the intervention requires no behavioral changes, requires minimal infrastructure, and is suitable for resource-constrained and high-risk environments. Boyce also hopes that the repellent properties of the engineered wraps may offer some protection to other members of the family, especially if they sleep together.
Research overview
To assess feasibility and effectiveness in a humanitarian context, researchers plan to begin a Phase III, double-blind, randomized controlled trial in the Kyawari refugee settlement in western Uganda. The settlement is home to approximately 150,000 refugees, mostly women and children, who were displaced by the conflict in the Democratic Republic of the Congo.
The three-year study (2026-2029) will enroll 450 recently arrived mother-infant pairs and compare three strategies: One is a long-lasting permethrin wrap that is factory processed and designed to maintain its repellent effect without reprocessing. Wrap soaked in 0.5% permethrin solution. It is a low cost and locally viable option. and untreated wrap as a control group.
Children are followed for six months, the period during which families are most likely to lack stable housing and consistent mosquito protection. Outcomes include malaria incidence, hospitalizations, safety, adherence, and user acceptability to assess both efficacy and real-world applicability.
Locally-led partnerships
This study builds on more than 10 years of collaborative malaria research. Community engagement and on-the-ground activities are supported by the People’s Health and Economic Development Agency (PHEALED), a Ugandan non-governmental organization with extensive experience in refugee and rural health programs.
Clinical activities will be carried out in collaboration with local health facilities run by Medical Team International in partnership with the Uganda Office of the United Nations High Commissioner for Refugees (UNHCR) to ensure alignment with existing care systems and support sustainability beyond the study period. Funding provided by the Thrasher Research Fund supports innovative global health solutions that put children at the center.
sauce:
Institute for Global Health and Infectious Diseases
Reference magazines:
https://www.nejm.org/doi/full/10.1056/NEJMoa2501628
