Enhancing protection against vector-borne diseases in forcibly displaced communities: evaluating the efficacy of spatial repellents for cutaneous leishmaniasis control in North-East Syria
Bibliographic record
Abstract
BACKGROUND: In Syria, during the 14 years after the outbreak of civil war, 16.7 million people have been forced to flee their homes, of which 7.2 million remain internally displaced in 2025. Breakdown in waste management caused by aerial bombardment has created ideal conditions for cutaneous leishmaniasis (CL) transmission, vectored by phlebotomine sandflies. Displaced populations reside in flimsy shelters where conventional vector control tools are operationally unfeasible. A small, lightweight, portable transfluthrin-based spatial repellent (Mosquito Shield™) has been developed which may circumvent some of these logistical issues and provide improved protection from vector-borne diseases in harsh environments. METHODS: A two-arm, non-randomised cluster trial was undertaken in Ar-Raqqa governorate, North-East Syria, to evaluate the efficacy of Mosquito Shield™ in reducing CL case incidence and sandfly densities in shelters. Weekly epidemiological monitoring was performed by MENTOR Initiative mobile clinics and supported health facilities. Entomological monitoring was performed fortnightly using indoor US Centers for Disease Control and Prevention light traps in 40 randomly selected households per study arm. Phlebotomine sandflies were morphologically identified; a subset were analysed for molecular species confirmation, blood-meal preferences and pyrethroid resistance. Household surveys and focus group discussions were used to assess intervention feasibility, acceptability and uptake. RESULTS: Assuming a 2-month diagnosis cut-off, the CL incidence rate was 9.9 and 5.2 per 1000 in the control and intervention arms, respectively; Mosquito Shield™ demonstrated a significant impact on rate of CL infection in all ages (incidence rate ratio; IRR: 0.52 [95% CI: 0.37-0.74]; p < 0.0001). Mosquito Shield™ demonstrated a significant impact on all female sandfly density (IRR: 0.22 [95% CI: 0.14-0.33]; p < 0.0001) and blood-fed female sandfly density (IRR: 0.21 [95% CI: 0.11-0.40]; p < 0.0001). Mosquito Shield™ was received positively and perceived to be easy to use, to protect from CL, sandflies and other insect bites and required minimal behaviour change. CONCLUSIONS: Trial findings provide the first demonstrable impact of spatial repellents on CL transmission, strengthening the growing evidence basis for the effectiveness of this intervention against multiple vector species and their associated pathogens. Study results strongly support the deployment of spatial repellents to control CL in humanitarian crises. TRIAL REGISTRATION: ClinicalTrials.gov, NCT06917040.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".