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Combining Indoor Residual Spraying and Insecticide-Treated Net Interventions

Does scaling up of malaria control by combining indoor residual spraying (IRS) and long-lasting insecticidal nets (LLIN) enhance protection to populations? Results from a literature search and from recent household surveys in Bioko, Equatorial Guinea, and Zambezia, Mozambique are presented. Five out of eight previous studies reported a reduced risk of infection in those protected by both interventions compared with one intervention alone. Surveys in Bioko and Zambezia showed strong evidence of a protective effect of IRS combined with nets relative to IRS alone (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.59–0.86 for Bioko, and OR = 0.63, 95% CI = 0.50–0.79, for Zambezia). The effect of both interventions combined, compared with those who had neither, was OR = 0.46, (95% CI = 0.76–0.81) in Bioko and 0.34 (95% CI = 0.21–0.56) in Zambezia. Although the effects of confounding cannot be excluded, these results provide encouragement that the additional resources for combining IRS and LLIN are justified.

Received January 30, 2009. Accepted for publication April 22, 2009.

^* Address correspondence to Immo Kleinschmidt, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. E-mail: Immo.Kleinschmidt{at}lshtm.ac.uk

Authors’ addresses: Immo Kleinschmidt, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom, Tel: +44 (0)20 7927 2103, E-mail: Immo.Kleinschmidt{at}lshtm.ac.uk. Christopher Schwabe and Jose Luis Segura Medical Care Development International, 8401 Colesville Rd Suite 425, Silver Spring MD 20910, Tel: (301) 562-1920, Fax: (301) 562-1921, E-mails: cschwabe{at}mcd.org and lsegura1212{at}gmail.com. Murugasampilay Shiva, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland, Tel: + 41 22 791 21 11, Fax: + 41 22 791 31 11, E-mail: shivam{at}who.int. Victor Sima, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea. Samuel Jose Alves Mabunda, Ministerio da Saude, Direccao Nacional de Promocao da Saude e Controlo de Doencas, Director do Programa Nacional de Controlo da Malaria, Av. Eduardo Mondlane/Salvador Allende, CP 264 Maputo, Mozambique, Tel: + 258 21328869, E-mail: sjamabunda{at}gmail.com. Michael Coleman, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom, and Medical Research Council, 491 Ridge Rd, Overport, Durban 4091, South Africa, Tel: +27 31 203 4700, Fax: +27 31 203 4704, E-mail: mcoleman{at}liverpool.ac.uk.