Treated baby wraps may reduce malaria risk in refugee infants

Malaria remains a threat to young children in refugee settlements, where displacement, temporary housing, and limited access to healthcare reduce the effectiveness of conventional prevention tools. There are an estimated 35 million refugees in Africa alone with women and children comprising more than 80% of those displaced. New arrivals lack permanent shelter, and therefore cannot reliably use bed nets-leaving infants and young children vulnerable to mosquito bites.

Ross Boyce, MD, MSc, a researcher with the Institute for Global Health and Infectious Diseases at the UNC School of Medicine, will lead a three-year study in collaboration with partners at the Mbarara University of Science and Technology in Uganda, evaluating a proven malaria prevention strategy tailored to humanitarian settings–supported by the Thrasher Research Fund.

The study will test permethrin-treated baby wraps, an innovation that transforms a cultural caregiving practice-mothers carrying infants on their backs using cloth wraps-into a protective barrier against malaria-carrying mosquitoes. The approach builds on strong clinical evidence. In a randomized, placebo-controlled trial conducted in western Uganda published in The New England Journal of Medicine (2025), Boyce found that infants carried in permethrin-treated wraps experienced approximately a 65% reduction in clinical malaria incidence, even bed net use. The results demonstrated meaningful protection beyond nets alone, particularly against outdoor and daytime mosquito exposure.

As global funding of humanitarian emergencies declines, newly arrived refugees are increasingly left to build their own shelters. If you don't have a bed, let alone a roof over your head, it's difficult to hang a bed net. By building protection into something mothers already use every day, we can reach infants at the moments and places they're most exposed."

Dr. Ross Boyce, associate professor of medicine and epidemiology

Embedding insect repellent into an item that families already use daily means the intervention requires no behavioral change, minimal infrastructure, and is well suited to resource-constrained, high-risk environments. Boyce is also hopeful that the repellency effect of the treated wrap might provide some protection to other members of the family, especially if they sleep close together.

Study overview

To assess feasibility and effectiveness in humanitarian contexts, researchers will launch a Phase III, double-blind, randomized controlled trial in the Kyangwali Refugee Settlement in western Uganda. The settlement is home to roughly 150,000 refugees, primarily women and children displaced by conflict in the Democratic Republic of Congo.

The three-year study (2026–2029) will enroll 450 recently arrived mother–infant pairs and compare three strategies: factory-treated, long-lasting permethrin wraps designed to retain repellency without re-treatment; wraps soaked in a 0.5% permethrin solution, a low-cost and locally feasible option; and untreated wraps serving as the control group

Children will be followed for six months, a period when families are most likely to lack stable housing and consistent mosquito protection. Outcomes will include malaria incidence, hospitalizations, safety, adherence, and user acceptability to evaluate both effectiveness and real-world applicability.

Locally led partnerships

The study draws on more than a decade of collaborative malaria research. Community engagement and field operations are supported by the Peoples' Health and Economic Development Organization (PHEALED), a Ugandan non-governmental organization with extensive experience in refugee and rural health programs.

Clinical activities will be conducted in collaboration with local health facilities operated by Medical Teams International in partnership with the Uganda Office of the United Nations High Commissioner on Refugees (UNHCR) , ensuring alignment with existing care systems and supporting sustainability beyond the study period. Funding provided by the Thrasher Research Fund supports innovative, child-focused global health solutions.