Volume 88, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Indoor residual spraying (IRS) with insecticide is now recommended for malaria control in high-transmission settings. However, concerns about insecticide resistance have increased. We conducted a cross-sectional household survey in high-transmission northern Uganda in two districts previously sprayed with pyrethroids before documentation of pyrethroid resistance and at least one round of carbamates and in one contiguous district that was not sprayed. Parasitemia prevalence among children < 5 years of age was lower in the two IRS districts compared with the non-sprayed district: 37.0% and 16.7% versus 49.8%, < 0.001. Anemia prevalence was also significantly lower in the two IRS districts: 38.8% and 36.8% versus 53.0%, < 0.001. Multivariable Poisson regression models indicated that a child living in a sprayed district had a 46% and 32% lower risk of parasitemia and anemia, respectively, than a child in a non-sprayed district ( < 0.001). Carefully managed IRS can significantly reduce malaria burden in high-transmission settings.


Article metrics loading...

Loading full text...

Full text loading...



  1. The World Health Organization, 2011. World Malaria Report. Geneva: World Health Organization.
  2. Pluess B, Tanser FC, Lengeler C, Sharp BL, , 2010. Indoor residual spraying for preventing malaria. Cochrane Database Syst Rev 4: CD006657.
  3. Mabaso ML, Sharp B, Lengeler C, , 2004. Historical review of malarial control in southern African with emphasis on the use of indoor residual house-spraying. Trop Med Int Health 9: 846856.[Crossref]
  4. The World Health Organization, 2006. Use of Indoor Residual Spraying for Scaling Up Global Malaria Control and Elimination. Geneva: World Health Organization.
  5. Skarbinski J, Mwandama D, Wolkon A, Luka M, Jafali J, Smith A, Mzilahowa T, Gimnig J, Campbell C, Chiphwanya J, Ali D, Mathanga DP, , 2012. Impact of indoor residual spraying with lambda-cyhalothrin on malaria parasitemia and anemia prevalence among children less than five years of age in an area of intense, year-round transmission in Malawi. Am J Trop Med Hyg 86: 9971004.[Crossref]
  6. Kigozi R, Baxi SM, Gasasira A, Sserwanga A, Kakeeto S, Nasr S, Rubahika D, Dissanayake G, Kamya MR, Filler S, Dorsey G, , 2012. Indoor residual spraying of insecticide and malaria morbidity in a high transmission intensity area of Uganda. PLoS One 7: e42857.[Crossref]
  7. The World Health Organization, 2011. The Technical Basis for Coordinated Action Against Insecticide Resistance: Preserving the Effectiveness of Modern Malaria Vector Control: Meeting Report. Geneva: The World Health Organization.
  8. Baleta A, , 2009. Insecticide resistance threatens malaria control in Africa. Lancet 374: 15811582.[Crossref]
  9. N'Guessan R, Corbel V, Akogbeto M, Rowland M, , 2007. Reduced efficacy of insecticide-treated nets and indoor residual spraying for malaria control in pyrethroid resistance area, Benin. Emerg Infect Dis 13: 199206.[Crossref]
  10. Ranson H, N'Guessan R, Lines J, Moiroux N, Nkuni Z, Corbel V, , 2011. Pyrethroid resistance in African anopheline mosquitoes: what are the implications for malaria control? Trends Parasitol 27: 9198.[Crossref]
  11. WHO Global Malaria Programme, 2012. Global Plan for Insecticide Resistance Management in Malaria Vectors. Geneva: World Health Organization.
  12. Uganda Malaria Surveillance Project, 2012. Malaria Intervention Coverage and Associated Morbidity Survey in Children Under Five Years: Indoor Residual Spraying in Northern Uganda and LLIN Coverage in Central Uganda. Kampala, Uganda.
  13. Uganda Bureau of Statistics, 2010. Uganda Malaria Surveillance Project Molecular Laboratory, National Malaria Control Programme, ICF Macro, 2010. Uganda Malaria Indicator Survey 2009. Kampala, Uganda.
  14. Okello PE, Van Bortel W, Byaruhanga AM, Correwyn A, Roelants P, Talisuna A, D'Alessandro U, Coosemans M, , 2006. Variation in malaria transmission intensity in seven sites throughout Uganda. Am J Trop Med Hyg 75: 219225.
  15. Yeka A, Gasasira A, Mpimbaza A, Achan J, Nankabirwa J, Nsobya S, Staedke SG, Donnelly MJ, Wabwire-Mangen F, Talisuna A, Dorsey G, Kamya MR, Rosenthal PJ, , 2012. Malaria in Uganda: challenges to control on the long road to elimination: I. Epidemiology and current control efforts. Acta Trop 121: 184195.[Crossref]
  16. Proietti C, Pettinato DD, Kanoi BN, Ntege E, Crisanti A, Riley EM, Egwang TG, Drakeley C, Bousema T, , 2011. Continuing intense malaria transmission in northern Uganda. Am J Trop Med Hyg 84: 830837.[Crossref]
  17. Okia M, , 2010. Preliminary Results of Insecticide Susceptibility Tests Conducted Using Alphacypermethrin 0.1% WHO Test Papers in Apac and Gulu Districts, January 2010. Kampala, Uganda.
  18. Okia M, Protopopoff N, , 2009. Report on Malaria Vector Susceptibility to Public Health Insecticides in Uganda September to October 2009. Kampala, Uganda: Stop Malaria Uganda Malaria Consortium.
  19. Roll Back Malaria Monitoring and Evaluation Reference Group, 2005. Malaria Indicator Survey: Basic Documentation for Survey Design and Implementation. Geneva: The World Health Organization.
  20. Rabe-Hesketh S, Skrondal A, Pickles A, , 2004. Generalized multilevel structural equation modeling. Psychometrika 69: 167190.[Crossref]
  21. Barros AJ, Hirakata VN, , 2003. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 3: 21.[Crossref]
  22. Filmer D, Pritchett LH, , 2001. Estimating wealth effects without expenditure data–or tears: an application to educational enrollments in states of India. Demography 38: 115132.
  23. Hawley WA, Phillips-Howard PA, ter Kuile FO, Terlouw DJ, Vulule JM, Ombok M, Nahlen BL, Gimnig JE, Kariuki SK, Kolczak MS, Hightower AW, , 2003. Community-wide effects of permethrin-treated bed nets on child mortality and malaria morbidity in western Kenya. Am J Trop Med Hyg 68: 121127.
  24. Larsen D, Angelwicz P, Eisele T, , 2011. Examining the community effect of insecticide-treated bed nets using survival analysis. Proceedings of the 60th Annual Meeting of the American Society of Tropical Medicine and Hygiene, Philadelphia, PA.
  25. Kim D, Fedak K, Kramer R, , 2012. Reduction of malaria prevalence by indoor residual spraying: a meta-regression analysis. Am J Trop Med Hyg 87: 117124.[Crossref]
  26. Nyarango PM, Gebremeskel T, Mebrahtu G, Mufunda J, Abdulmumini U, Ogbamariam A, Kosia A, Gebremichael A, Gunawardena D, Ghebrat Y, Okbaldet Y, , 2006. A steep decline of malaria morbidity and mortality trends in Eritrea between 2000 and 2004: the effect of combination of control methods. Malar J 5: 33.[Crossref]
  27. Protopopoff N, Van Bortel W, Marcotty T, Van Herp M, Maes P, Baza D, D'Alessandro U, Coosemans M, , 2007. Spatial targeted vector control in the highlands of Burundi and its impact on malaria transmission. Malar J 6: 158.[Crossref]
  28. Kleinschmidt I, Schwabe C, Shiva M, Segura JL, Sima V, Mabunda SJ, Coleman M, , 2009. Combining indoor residual spraying and insecticide-treated net interventions. Am J Trop Med Hyg 81: 519524.
  29. Hamel MJ, Otieno P, Bayoh N, Kariuki S, Were V, Marwanga D, Laserson KF, Williamson J, Slutsker L, Gimnig J, , 2011. The combination of indoor residual spraying and insecticide-treated nets provides added protection against malaria compared with insecticide-treated nets alone. Am J Trop Med Hyg 85: 10801086.[Crossref]
  30. Bekele D, Belyhun Y, Petros B, Deressa W, , 2012. Assessment of the effect of insecticide-treated nets and indoor residual spraying for malaria control in three rural kebeles of Adami Tulu District, South Central Ethiopia. Malar J 11: 127.[Crossref]
  31. Kleinschmidt I, Torrez M, Schwabe C, Benavente L, Seocharan I, Jituboh D, Nseng G, Sharp B, , 2007. Factors influencing the effectiveness of malaria control in Bioko Island, equatorial Guinea. Am J Trop Med Hyg 76: 10271032.

Data & Media loading...

  • Received : 12 Dec 2012
  • Accepted : 28 Jan 2013

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error