Permethrin-treated baby wraps for the prevention of malaria in children: Protocol for a double-blind, randomized placebo-controlled controlled trial in western Uganda

This article details the study protocol for a double-blind, randomized placebo-controlled trial to determine the effectiveness of permethrin-treated baby wraps to prevent Plasmodium falciparum malaria infection in children 6–24 months of age. Participating mother-infant dyads will be randomized to receive either a permethrin-treated or a sham-treated wrap, known locally as a “lesu.” After a baseline home visit, during which time all participants will receive new long-lasting insecticidal nets, participants will attend scheduled clinic visits every two weeks for a period of 24 weeks. In the event of an acute febrile illness or other symptoms that may be consistent with malaria (e.g., poor feeding, headache, malaise), participants will be instructed to present to their respective study clinic for evaluation. The primary outcome of interest is the incidence of laboratory-confirmed, symptomatic malaria in participating children. Secondary outcomes of interest include: (1) change in children’s hemoglobin levels; (2) change in children’s growth parameters; (3) prevalence of asymptomatic parasitemia in children; (4) hospitalization for malaria in children; (5) change in the mother’s hemoglobin level; and (6) clinical malaria in the mother. Analyses will be conducted using a modified intent-to-treat approach, with woman-infant dyads who attend one or more clinic visits analyzed according to the arm to which they were randomly assigned. This is the first use of an insecticide-treated baby wrap for prevention of malaria in children. The study began recruitment in June 2022 and is ongoing. ClinicalTrials.gov Identifier: NCT05391230, Registered 25 May 2022

O018 A virtual reality training platform for surgeons, anaesthetists, and obstetricians in low and middle-income countries

Introduction Many surgeons, anaesthetists, and obstetricians in low and middle-income countries (LMICs) lack access to training opportunities. The purpose of this study was to evaluate the feasibility of VR procedural training at scale for these specialties. Methods An online, free to participant, single-day event programme was designed to cover operative anatomy and procedural steps for Bellwether procedures including Laparotomy and Caesarean section, use of a novel gasless laparoscopic surgery device, administration of spinal anaesthetic and basic trauma principles. Demonstration was performed using fresh frozen cadavers and virtual presentations. Faculty comprised of an equal split between UK and LMIC surgeons from a range of countries virtually connected. The 4K live 360°VR broadcast was achieved via vMix virtual video switcher. vMix Call remote broadcast contributor links and additional angles via NDI IP system. Results A total of 236 unique live views were generated. Participants were from 43 countries (n=17 high income countries: n=26 LMICs). In addition, fifty cardboard headsets were transported to two sites for dissemination to local trainees and students: Nairobi, Kenya, and Delhi, India. The mean per-user engagement time for the group was 132 minutes. Nine LMICs had an average per country user engagement of >140 minutes. Conclusion It is feasible to live stream surgical training videos in VR and achieve significant user engagement for participants from LMICs. This technology allowed resources and faculty in a HIC setting to collaborate in real-time with faculty input from LMIC via virtual reality, facilitating multi-directional learning. Take-home message Live virtual reality surgical training courses are feasible and can provide scalable learning environments, achieving significant engagement from surgeons, obstetricians and anaesthetists across the world, including several low and middle-income countries