Background. The spread of artemisinin resistant malaria from SE Asia to the rest of the world remains a threat that will only be
ended by eliminating malaria from the region. Novel control approaches are required to mitigate this threat. Spatial repellents
(SR) are one such approach. We therefore conducted a multiple cross-over experiment from April 2013 – April 2014, in which
all houses in one of two villages in Mondolkiri Province, Cambodia were alternately supplied with an emanator of the spatial
repellent metofluthrin per 30 m3 of protected area to cover all potential peridomestic areas where people might spend their time
before sleeping. Emanators were replaced every month for a three-month period.
Material and methods. Mosquito densities were simultaneously monitored in each village for two weeks every month using six
CDC light-traps/night run from 18.00 to 07.00 hrs inside bedrooms and malaria prevalence, seroconversion and gSG6 protein
rates assessed from prevalence surveys. After emanators were installed in the first village they were installed in the second
village for a further three-month period and following that were again used in the initial village for a further three months.
Surveys were undertaken before the initial installation of the emanators and at each cross-over point.
Results. Anopheles dirus densities were highest in houses closest to the forest. Transmission rates were low even before the
application of the emanators. Perhaps due to the low levels of malaria transmission in Mondolkiri no significant relationships
were found in Plasmodium cases or seroconversion rates between villages, surveys or by intervention. Adult males, who might
spend more time unprotected in the forest at night, appeared to be at greater risk of becoming infected with P. falciparum
malaria as compared to women or young children.
Conclusion. At the malaria transmission levels present in Mondolkiri the metofluthrin emanators evaluated had no observable
effect on malaria prevalence. This may be due to confounding by low prevalence rates