Increases in bed net coverage and antimalarial treatment have reduced the risk of malaria in sub-Saharan Africa. However, the pace of reduction has slowed, and new tools are needed to reverse this trend. We evaluated houses screened with insecticide-treated ceiling nets using a cluster randomized-controlled trial in western Kenya. The primary endpoints were Plasmodium falciparum PCR-positive prevalence (PCRPfPR) of children from 7 months to 10 years old and anopheline density. Ceiling nets and bed nets were provided to 1073 houses, and 1162 houses were provided with bed nets only. The treatment and control arms each had four clusters. We conducted three epidemiological and entomological post-intervention surveys over the course of a year and a half. Each epidemiological survey targeted 150 children per cluster, and entomological surveys targeted 25 houses. When the three surveys were combined, the median PCRPfPRs were 23% (IQR 8%) in the intervention arm and 42% (IQR 12%) in the control arm. The adjusted risk ratio (RR) was 0.53 [95% confidence interval (CI) 0.41–0.71; P = 0.029]. The median anopheline densities were 0.4 (IQR 0.4) and 2.0 (IQR 1.4), respectively. The adjusted RR was 0.41 (95% CI 0.29–0.90; P = 0.029). The present study indicates additional protection from insecticide-screened ceilings over the current best practice.

Entomological indicators such as vector density, distribution, biology and bionomics and their vectorial attributes are important parameters for measuring the pattern and intensity of malaria transmission. Although published articles provide evidence for the existence of associations between entomological indices and malaria transmission dynamics, none of them is able to establish a strong correlation. In order to address this issue, the present study aims to assess how malaria transmission is influenced and can be predicted by local major vector dynamics. We carried out an entomological assessment of major Anopheline vector abundance, habit/habitat, resting and feeding behavior, infectivity rates, and other entomological parameters. Results suggest that malaria transmission was correlated with a vector control intervention and non-intervention scenario in a high endemic region of Kalahandi district of Odisha, India. Amongst all indices, infective anthropophagic vectors established a strong positive correlation with malaria morbidity in comparison to infective or anthropophagic vector species during both the study periods. Though other entomological parameters influenced the transmission intensity, little quantifiable association was detected among study sites. This study provides strong baseline evidence of an association between entomological indices and malaria transmission dynamics, which could be used as an early warning system for outbreak prediction.