TOPLINE:

Permethrin-treated baby wraps reduced the incidence of clinical malaria in babies in Uganda by 66% compared with sham-treated wraps over 24 weeks, even when used alongside insecticide-treated bed nets. The intervention was also safe, with no serious adverse events leading to discontinuation.

METHODOLOGY:

• Researchers conducted a randomized, placebo-controlled trial to assess whether permethrin-treated baby wraps could reduce the incidence of malaria in western Uganda, where Plasmodium falciparum transmission is moderate and perennial, with seasonal peaks.
• They enrolled adult women with babies aged 6-18 months, who were randomly assigned to receive either 0.5% permethrin-treated wraps (n = 200) or sham-treated wraps (n = 200). Retreatment occurred every 4 weeks, and follow-up visits occurred every 2 weeks for 24 weeks.
• All women also received new long-lasting insecticide-treated bed nets containing only pyrethroid. They also kept logs of bed net and wrap use.
• The primary outcome was clinical malaria in children, defined as fever (temperature ≥ 38 °C) or reported fever within the past 24 hours accompanied by a positive result on a malaria rapid diagnostic test.

TAKEAWAY:

• Babies whose mothers used permethrin-treated wraps had a 66% lower incidence of clinical malaria than those whose mothers used sham-treated wraps (incidence rate ratio, 0.34; P < .001).
• Over 24 weeks, the risk for a first clinical malaria episode was lower with the permethrin-treated wrap than with the sham-treated wrap (0.16 vs 0.34; risk ratio, 0.48; 95% CI, 0.33-0.69).
• Hospitalization for malaria treatment occurred in 7 vs 17 children in the permethrin-treated group vs the sham-treated group.
• Rash was reported more frequently in the permethrin-treated group than in the sham-treated group; however, all cases were mild, and none led to trial discontinuation. No serious adverse events were observed in the permethrin-treated group.

IN PRACTICE:

“On the basis of the assumption that the wraps primarily provided protection against mosquito biting at times when the children were not under a bed net, they could work synergistically with household-based interventions such as long-lasting insecticide-treated bed nets and indoor residual spraying,” the authors of the study wrote.

SOURCE:

The study was led by Ross M. Boyce, MD, University of North Carolina at Chapel Hill. It was published online on September 24, 2025, in The New England Journal of Medicine.

LIMITATIONS:

The study findings are most applicable to contexts where wraps are traditionally used to carry young children. The research was conducted in a single geographic area. Although participants reported high rates of bed net use and wrap washing, these self-reported measures may be subject to social desirability or recall biases.

DISCLOSURES:

This study was supported by a Clinical Scientist Development Award from the Doris Duke Foundation and grants from the National Institutes of Health. Sawyer Products provided bottles of 40% permethrin solution at no cost to the trial.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.