Researchers in Uganda have found that treating baby-carrying wraps with the insect repellent permethrin reduced malaria cases in infants by almost two-thirds.
Malaria kills more than 600,000 people worldwide each year, most of them children under the age of five in Africa.
The trial involved 400 mothers and babies aged around six months in Kasese, a rural and mountainous area in western Uganda. Half of the mothers were given wraps, known locally as lesus, treated with permethrin. The others used untreated wraps that had been dipped in water as a placebo.
Researchers followed the families for six months, re-treating the wraps once a month and monitoring which babies developed malaria.
Babies carried in the treated wraps were two-thirds less likely to contract the disease. There were 0.73 cases of malaria per 100 babies each week in the treated group, compared with 2.14 in the untreated group.
At a community meeting to share the findings, one mother told researchers: “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.”
Professor Edgar Mugema Mulogo, a public health specialist at Mbarara University of Science and Technology and co-lead investigator, said the scale of the results exceeded expectations.
“We suspected there would be some benefit,” he said. “What was quite outstanding was the magnitude.”
His co-lead investigator, Dr Ross Boyce of the University of North Carolina at Chapel Hill, said he initially struggled to believe the findings and asked for the data to be checked again.
“I wasn’t sure it was going to work,” he said. “But that’s why we do studies.”
Malaria-carrying mosquitoes typically bite at night, which is why bed nets have been central to prevention efforts. However, researchers say mosquitoes are increasingly biting earlier in the evening or early in the morning, possibly adapting to widespread bed net use.
Mulogo said this left people vulnerable before bedtime, particularly in rural areas where families often cook and eat outdoors.
“Before you go to bed, when you’re outside, we need solutions that prevent those bites,” he said.
Wraps are widely used in these communities, not only for carrying babies but also as shawls, bed sheets and aprons. Mulogo said treated wraps could become part of a broader package of malaria prevention tools, adding that demand had already grown in participating communities.
Ugandan health officials and international malaria experts at the World Health Organization have expressed interest in the research. The approach could help protect babies as immunity passed on from their mothers fades, often before vaccination is possible.
The findings build on earlier research in Afghan refugee camps, where treating shawls with insecticide also reduced malaria rates. WHO guidelines already recognise permethrin-treated clothing as a form of personal protection.
Mulogo said local production of treated wraps could one day be possible. “It presents a very good business opportunity for local industry,” he said.
Researchers cautioned that further studies are needed before any large-scale rollout, including trials in different settings.
Boyce said permethrin has a strong safety record and has been used on textiles for decades, including by the US military. Babies in the treated group were slightly more likely to develop rashes, at 8.5% compared with 6%, but none were serious enough to stop participation.
Both researchers said further work was needed to confirm safety, though the benefits were likely to outweigh the risks.
Boyce also hopes to explore whether treating school uniforms could reduce malaria rates, but said funding for future research had not yet been secured.
He added that the simplicity of the intervention could make it attractive to donors. “It’s not complicated,” he said. “We took some cloth, soaked it, and it’s very cheap.”
