PONE-D-25-21398

Efficacy of Ceiling-Mounted Mosquito Nets for Malaria Vector Control in a Peruvian Amazon Riverine Community: A Stepped-Wedge Cluster Randomized Trial

PLOS ONE

Dear Dr.  Quispe,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Specifically, while both reviewers felt the draft manuscript was strong and well-written, though Reviewer 1 felt like there were several areas that needed additional clarification before being further considered for publication, in particular the mosquito collection methodology in addition to several other areas throughout the manuscript. Reviewer 2 additionally felt like the draft could benefit from additional clarity and changes in the abstract.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Review results

The authors aim to assess the effectiveness of ceiling-mounted mosquito nets in reducing Anopheles mosquito density both indoors and outdoors, with a focus on entomological aspects. General comments address the unclear procedural elements of this study, particularly concerning cluster allocation and the execution of HLC activities before, during, and after the intervention in the three study clusters.

ABSTRACT

1. Line 21-22: "We aimed to assess the effectiveness of ceiling-mounted mosquito nets in reducing Anopheles mosquito density both indoors and outdoors."

Based on the results obtained, it can be concluded that ceiling-mounted mosquito nets are only effective in indoor settings. How does the research objective describe the results in outdoor settings? It is recommended that the research objective avoid using the words 'indoors' and 'outdoors' (to assess the effectiveness of ceiling-mounted mosquito nets in reducing Anopheles mosquito density).

2. Line 26-29: "We measured entomological indices using human landing catches and other standardized methods, focusing on Anopheles mosquito counts, bites per person per night (BPN), and bites per person per hour (BPH), both indoors and outdoors."

Are these entomological endpoints ('mosquito counts', 'BPN', and 'BPH') analysed from the same HLC results? I think these variables have the same meaning.

3. Was there also an analysis comparing malaria cases in renovated and non-renovated households during the intervention periods?

INTRODUCTION

4. Line 67-69: "This strategy not only prevents mosquito entry but also targets mosquitoes that come into contact with the treated surfaces, potentially reducing both indoor and outdoor mosquito populations."

Please add references that support the statement, particularly those that address reducing the outdoor mosquito population.

STUDY DESIGN

5. Line 105-106: "Briefly, we planned the study including three clusters of Llanchama households randomly selected,"

What is the basis for the randomisation of clusters? Is it a comparison of house types (later referred to as types B, C, and D) within one cluster, or is it simply the number of houses grouped closely together at the study sites?

6. There are no marks or clear boundaries for each cluster on the study map (see Supplementary Material S2).

7. What is the distance between clusters?

8. If the clusters did not have clear boundaries, it would be possible for houses from different clusters to be very close to each other. Considering that Anopheles can fly quite long distances, would there be any bias if Anopheles could not enter a treated house, but could fly to an untreated house next door?

9. Line 111: Table 1 does not show how long it takes to install ceiling-mounted mosquito nets in households that received the intervention. Can installation be carried out in all households in a cluster simultaneously in a short time (less than one day)? Or did it take three months, including the installation process, for all households to ultimately benefit?

STUDY INTERVENTION

10. Lines 137–139: 'Homes with large cracks or exposed sections in wooden plank walls had these areas covered with mosquito netting to reduce entry points further.'

Are there any records of how many houses received additional improvements involving mosquito nets on the walls?

STUDY OUTCOMES

11. Line 152–153: 'Captured indoors and outdoors via human landing catches (HLCs).'

This is not explained in detail:

• How many times were HLCs conducted on two consecutive nights in each cluster, for example, once a week or biweekly?

• How many sentinel houses were there, and where were they located within the cluster?

STUDY PROCEDURES

12. Line 184–186: 'Before the intervention was introduced, baseline entomological assessments were conducted in all households to determine the initial density of mosquitoes and the extent of human exposure to bites.'

Did the HLCs conduct baseline entomological assessments in all 69 households?

SAMPLE SIZE

13. Line 210: What are the differences between house types A, B, C, and D? Could you please provide the classification criteria for house types A, B, C, and D, along with pictures if possible? You can include the explanation in Supplementary Section S2.

RESULTS

14. Lines 298–300: Outdoor BPN (Fig. 2D), indoor BPH (Fig. 2E), and outdoor *BPN (Fig. 2F). IQR should be BPH.

15. Line 299: Interquartile Range; *CMMN: Ceiling-mounted Mosquito Nets (does not refer to Figure 2).

16. Line 303–304: IQR (interquartile range); BPN (bites per person per night); *BPN (bites per person per hour); grey shadow (intervention period). (Should be 'BPH', bites per person per hour.)

DISCUSSION

17. The effect of CMMN on non-Anopheles mosquitoes is worth discussing, particularly given that the number of Anopheles mosquitoes decreased indoors and outdoors during the study period.

Reviewer #2: Thank you for the opportunity to review this manuscript. This is the good manuscript as it is portraying a new intervention that can be used to control mosquito-borne diseases especially indoor transmissions. Great work

Abstract

Statistical analysis (how the data were analyzed) is missing in the abstract section. It is important to appear in the abstract section

Line 40: I don’t think funding is part of the abstract. The authors should revise the journal submission guidelines if this adheres to these guidelines

Introduction section

Line 47-49 Authors have described the vector control tools such as ITNs and IRS. Could the authors describe the challenges that may be facilitating the persistence of malaria transmission despite the use of these traditional interventions?

The Introduction is well narrated

Materials and methods

The method section is well explained and it is sufficient. The study design, study procedures and data analysis section are well narrated. The authors have done a good job

Results

Line 265-280 should be moved to the methods section

Discussion

I have no comment in the discussion section, it is well written and it made the study very important.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Review comments to authors.docx

Efficacy of Ceiling-Mounted Mosquito Nets for Malaria Vector Control in a Peruvian Amazon Riverine Community: A Stepped-Wedge Cluster Randomized Trial

PONE-D-25-21398R1

Dear Dr. Quispe,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

James Colborn

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewer #1:

Reviewer #2:

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I have reviewed the revised manuscript.

The authors have integrated their responses into the text.

I have no further comments.

Reviewer #2: the answers I provided above shows how this article is worthy to be published in this journal. Firstly, it indicates the new intervention that can be used to control mosquito-borne disease vectors especially malaria. Secondly, it indicates that new interventions can be combined with other core interventions such as ITNs and IRS to reduce contact between human and malaria vectors.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Reviewer comments_Sept 2025.pdf