A simple, centuries-old practice of carrying babies in cloth wraps could become a powerful new weapon in the global fight against malaria, according to a groundbreaking study from Uganda.
A Lifesaving Soak: The Power of Permethrin
Researchers have discovered that treating the traditional fabric wraps, known locally as lesus, with a common and inexpensive insect repellent dramatically cuts malaria rates in the infants carried within them. The study, conducted in the rural, mountainous district of Kasese in western Uganda, involved 400 mothers and their babies, who were around six months old.
The trial split participants into two groups: one received wraps treated with the insecticide permethrin, while the other used standard wraps dipped in water as a placebo. Over six months, with the wraps re-treated monthly, the results were striking. Babies carried in the permethrin-soaked fabric were two-thirds less likely to develop malaria. The weekly incidence was 0.73 cases per 100 babies in the treated group, compared to 2.14 cases in the control group.
One mother, attending a community session on the findings, powerfully testified: "I've had five children. This is the first one that I've carried in a treated wrap, and it's the first time I've had a child who has not had malaria."
Filling a Critical Gap in Protection
The innovation addresses a growing challenge in malaria control. While insecticide-treated bed nets have been a cornerstone of prevention, mosquitoes are increasingly biting outside of nighttime hours, in the early evening and morning—a possible adaptation to net use.
"Before you go to bed, when you're outdoors... we also need to find a solution ensuring that we can prevent those bites likely to transmit malaria," explained co-lead investigator Professor Edgar Mugema Mulogo from Mbarara University of Science and Technology. He noted that wraps are ubiquitous in these communities, used not only for carrying infants but also as shawls, bedsheets, and aprons, making them a versatile protective tool.
Malaria kills over 600,000 people annually, with the vast majority being African children under five years old. This intervention is particularly crucial for young babies, as the protective antibodies they receive from their mothers begin to wane, often before they are eligible for vaccination.
Pathway to Wider Use and Future Research
The research team, co-led by Dr Ross Boyce from the University of North Carolina, was astounded by the magnitude of the success. "I wasn't sure it was going to work, to be honest with you," said Boyce. "But that's why we do studies." The insecticide has a strong safety profile and has been used on textiles for years, notably by the US military.
While babies in treated wraps had a slightly higher incidence of minor rashes (8.5% vs 6%), none were severe enough to cause withdrawal from the study. The researchers acknowledge that further safety confirmation is needed but believe the immense benefits far outweigh the potential risks.
Both Ugandan health officials and the World Health Organization have expressed interest in the findings, which build on earlier successful research treating shawls in Afghan refugee camps. Professor Mulogo sees potential for local production, calling it "a very good business opportunity." However, the researchers caution that evidence from other settings is needed before any widespread rollout.
Dr Boyce highlighted the intervention's compelling simplicity for funders: "We took some cloth and we soaked it. And it's dirt cheap." He is now keen to explore whether treating school uniforms could similarly reduce malaria rates in older children, though funding for the next research phase is not yet secured.
