Quantifying and characterizing hourly human exposure to malaria vectors bites in rural southwest Burkina Faso

Background To sustain the efficacy of malaria vector control, the World Health Organization (WHO) recommends the combination of effective tools. Before designing and implementing additional strategies in any setting, it is critical to monitor or predict when and where transmission occurs. However, to date, very few studies have quantified the behavioural interactions between humans and Anopheles vectors. Here, we characterized residual transmission in a rural area of Burkina Faso where long lasting insecticidal nets (LLIN) are widely used. Methods We analysed data on both human and malaria vectors behaviours from 27 villages to measure hourly human exposure to vector bites in dry and rainy seasons using mathematical models. We estimated the protective efficacy of LLINs and characterised where (indoors vs . outdoors) and when both LLIN users and non-users were exposed to vector bites. Results The percentage of the population who declared sleeping under a LLIN the previous night was very high regardless of the season, with an average LLIN use ranging from 92.43% to 99.89%. The use of LLIN provided > 80% protection against exposure to vector bites. The proportion of exposure for LLIN users was 29-57% after 05:00 and 0.05-12 % before 20:00. More than 80% of exposure occurred indoors for LLIN users and the estimate reached 90% for children under five years old in the dry cold season. Conclusions This study supports the current use of LLIN as a primary malaria vector control tool. It also emphasises the need to complement LLIN with indoor-implemented measures such as indoor residual spraying (IRS) and/or house improvement to effectively combat malaria in the rural area of Diébougou. Furthermore, malaria elimination programmes would also require strategies that target outdoor biting vectors to be successful in the area. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was part of the REACT project, funded by the French Initiative 5% - Expertise France (No. 15SANIN213). ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. * (ER) : Endophagy Rate IRS : Indoor Residual Spraying LLIN : Long-Lasting Insecticidal Nets ODK : Open Data Kit NMCP : National Malaria Control Programs WHO : World Health Organization