Volume 86, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Little is known about the impact of indoor residual spraying (IRS) in areas with intense malaria transmission such as sub-Saharan Africa. In Malawi, IRS with lambda-cyhalothrin has been applied annually in an area of intense year-long transmission since 2007. We evaluated the impact of IRS on parasitemia and anemia prevalence in children less than five years of age by using a cross-sectional household survey conducted in 2009, six months after the second IRS spray round. We measured malaria parasitemia and anemia (hemoglobin level < 11 g/dL) in 899 children less than five years of age and used binomial regression to assess the impact of IRS by comparing children living in a household sprayed with IRS (direct IRS) with those in a household not sprayed with IRS, but in an IRS area (indirect IRS) and those living in a household not sprayed with IRS and not in an IRS area (no IRS). In the IRS area, 77% of households reported receiving IRS. Adjusting for bed net use, house construction, and socioeconomic status, we found that receiving direct IRS and indirect IRS were significantly associated with a 33% (95% confidence interval [CI] = 1–54%) and 46% (95% CI = 20–64%) reduction in parasitemia and a 21% (95% CI = 4–34%) and 30% (95% CI = 12–45%) reduction in anemia prevalence, respectively.

[open-access] This is an Open Access article distributed under the terms and of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, Global Malaria Programme, 2006. Indoor Residual Spraying: Use of Indoor Residual Spraying for Scaling Up Global Malaria Control and Elimination. Geneva: World Health Organization. [Google Scholar]
  2. World Health Organization, Global Malaria Programme, 2007. Insecticide-Treated Mosquito Nets: A Position Statement. Geneva: World Health Organization. [Google Scholar]
  3. Killeen GF, Smith TA, Ferguson HM, Mshinda H, Abdulla S, Lengeler C, Kachur SP, , 2007. Preventing childhood malaria in Africa by protecting adults from mosquitoes with insecticide-treated nets. PLoS Med 4: e229.[Crossref] [Google Scholar]
  4. Binka FN, Indome F, Smith T, , 1998. Impact of spatial distribution of permethrin-impregnated bed nets on child mortality in rural northern Ghana. Am J Trop Med Hyg 59: 8085. [Google Scholar]
  5. 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. [Google Scholar]
  6. Lengeler C, , 2004. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database Syst Rev CD000363. [Google Scholar]
  7. Najera JA, Gonzalez-Silva M, Alonso PL, , 2011. Some lessons for the future from the Global Malaria Eradication Programme (1955–1969). PLoS Med 8: e1000412.[Crossref] [Google Scholar]
  8. Curtis CF, Mnzava AE, , 2000. Comparison of house spraying and insecticide-treated nets for malaria control. Bull World Health Organ 78: 13891400. [Google Scholar]
  9. Molineaux L, Gramiccia G, , 1980. The Garki Project. Research on the Epidemiology and Control of Malaria in the Sudan Savanna of West Africa. Geneva: World Health Organization. [Google Scholar]
  10. Matola YG, Magayuka SA, , 1981. Malaria in the Pare area of Tanzania. V. Malaria 20 years after the end of residual insecticide spraying. Trans R Soc Trop Med Hyg 75: 811813.[Crossref] [Google Scholar]
  11. Pluess B, Tanser FC, Lengeler C, Sharp BL, , 2010. Indoor residual spraying for preventing malaria. Cochrane Database Syst Rev CD006657. [Google Scholar]
  12. Curtis CF, Maxwell CA, Finch RJ, Njunwa KJ, , 1998. A comparison of use of a pyrethroid either for house spraying or for bednet treatment against malaria vectors. Trop Med Int Health 3: 619631.[Crossref] [Google Scholar]
  13. 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] [Google Scholar]
  14. Protopopoff N, Van Bortel W, Marcotty T, Van Herp M, Maes P, Baza D, D'Alessandro U, Coosemans M, , 2008. Spatial targeted vector control is able to reduce malaria prevalence in the highlands of Burundi. Am J Trop Med Hyg 79: 1218. [Google Scholar]
  15. Protopopoff N, Van Herp M, Maes P, Reid T, Baza D, D'Alessandro U, Van Bortel W, Coosemans M, , 2007. Vector control in a malaria epidemic occurring within a complex emergency situation in Burundi: a case study. Malar J 6: 93.[Crossref] [Google Scholar]
  16. Kleinschmidt I, Sharp B, Benavente LE, Schwabe C, Torrez M, Kuklinski J, Morris N, Raman J, Carter J, , 2006. Reduction in infection with Plasmodium falciparum one year after the introduction of malaria control interventions on Bioko Island, Equatorial Guinea. Am J Trop Med Hyg 74: 972978. [Google Scholar]
  17. Sharp B, van Wyk P, Sikasote JB, Banda P, Kleinschmidt I, , 2002. Malaria control by residual insecticide spraying in Chingola and Chililabombwe, Copperbelt Province, Zambia. Trop Med Int Health 7: 732736.[Crossref] [Google Scholar]
  18. Sharp BL, Kleinschmidt I, Streat E, Maharaj R, Barnes KI, Durrheim DN, Ridl FC, Morris N, Seocharan I, Kunene S, La Grange JJ, Mthembu JD, Maartens F, Martin CL, Barreto A, , 2007. Seven years of regional malaria control collaboration–Mozambique, South Africa, and Swaziland. Am J Trop Med Hyg 76: 4247. [Google Scholar]
  19. Sharp BL, Ridl FC, Govender D, Kuklinski J, Kleinschmidt I, , 2007. Malaria vector control by indoor residual insecticide spraying on the tropical island of Bioko, Equatorial Guinea. Malar J 6: 52.[Crossref] [Google Scholar]
  20. Beier JC, , 2008. Malaria control in the highlands of Burundi: an important success story. Am J Trop Med Hyg 79: 12. [Google Scholar]
  21. 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] [Google Scholar]
  22. Kolaczinski K, Kolaczinski J, Kilian A, Meek S, , 2007. Extension of indoor residual spraying for malaria control into high transmission settings in Africa. Trans R Soc Trop Med Hyg 101: 852853.[Crossref] [Google Scholar]
  23. Yukich JO, Lengeler C, Tediosi F, Brown N, Mulligan JA, Chavasse D, Stevens W, Justino J, Conteh L, Maharaj R, Erskine M, Mueller DH, Wiseman V, Ghebremeskel T, Zerom M, Goodman C, McGuire D, Urrutia JM, Sakho F, Hanson K, Sharp B, , 2008. Costs and consequences of large-scale vector control for malaria. Malar J 7: 258.[Crossref] [Google Scholar]
  24. Guyatt HL, Kinnear J, Burini M, Snow RW, , 2002. A comparative cost analysis of insecticide-treated nets and indoor residual spraying in highland Kenya. Health Policy Plan 17: 144153.[Crossref] [Google Scholar]
  25. Goodman CA, Mnzava AE, Dlamini SS, Sharp BL, Mthembu DJ, Gumede JK, , 2001. Comparison of the cost and cost-effectiveness of insecticide-treated bednets and residual house-spraying in KwaZulu-Natal, South Africa. Trop Med Int Health 6: 280295.[Crossref] [Google Scholar]
  26. 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. [Google Scholar]
  27. Yakob L, Dunning R, Yan G, , 2011. Indoor residual spray and insecticide-treated bednets for malaria control: theoretical synergisms and antagonisms. J R Soc Interface 8: 799806.[Crossref] [Google Scholar]
  28. Chitnis N, Schapira A, Smith T, Steketee R, , 2010. Comparing the effectiveness of malaria vector-control interventions through a mathematical model. Am J Trop Med Hyg 83: 230240.[Crossref] [Google Scholar]
  29. 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] [Google Scholar]
  30. President's Malaria Initiative, 2011. President's Malaria Initiative Malaria Operational Plan Malawi FY 2011. Available at: http://www.fightingmalaria.gov/countries/mops/fy11/malawi_mop-fy11.pdf. Accessed April 4, 2011. [Google Scholar]
  31. National Statistical Office (NSO) Malawi, 2009. 2008 Population and Housing Census. Zomba, Malawi: National Statistical Office (NSO) Malawi. [Google Scholar]
  32. Mathanga DP, Walker ED, Wilson ML, Ali D, Taylor TE, Laufer MK, , 2012. Malaria control in Malawi: current status and directions for the future. Acta Trop 121: 212217.[Crossref] [Google Scholar]
  33. Mapping Malaria Risk in Africa (MAP MARA), Map of the Distribution of Endemic Malaria and Duration of Transmission Season in Malawi. Available at: http://www.mara.org.za/. Accessed October 6, 2011. [Google Scholar]
  34. Skarbinski J, Mwandama D, Luka M, Jafali J, Wolkon A, Townes D, Campbell C, Zoya J, Ali D, Mathanga DP, , 2011. Impact of health facility-based insecticide treated bednet distribution in Malawi: progress and challenges towards achieving universal coverage. PLoS ONE 6: e21995.[Crossref] [Google Scholar]
  35. Vanden Eng JL, Wolkon A, Frolov AS, Terlouw DJ, Eliades MJ, Morgah K, Takpa V, Dare A, Sodahlon YK, Doumanou Y, Hawley WA, Hightower AW, , 2007. Use of handheld computers with global positioning systems for probability sampling and data entry in household surveys. Am J Trop Med Hyg 77: 393399. [Google Scholar]
  36. 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. [Google Scholar]
  37. McKenzie DJ, , 2005. Measuring inequality with asset indicators. J Popul Econ 18: 229260.[Crossref] [Google Scholar]
  38. Hunt R, Edwardes M, Coetzee M, , 2010. Pyrethroid resistance in southern African Anopheles funestus extends to Likoma Island in Lake Malawi. Parasit Vectors 3: 122.[Crossref] [Google Scholar]
  39. Brooke BD, Kloke G, Hunt RH, Koekemoer LL, Temu EA, Taylor ME, Small G, Hemingway J, Coetzee M, , 2001. Bioassay and biochemical analyses of insecticide resistance in southern African Anopheles funestus (Diptera: Culicidae). Bull Entomol Res 91: 265272.[Crossref] [Google Scholar]
  40. Casimiro S, Coleman M, Mohloai P, Hemingway J, Sharp B, , 2006. Insecticide resistance in Anopheles funestus (Diptera: Culicidae) from Mozambique. J Med Entomol 43: 267275.[Crossref] [Google Scholar]
  41. Casimiro SL, Hemingway J, Sharp BL, Coleman M, , 2007. Monitoring the operational impact of insecticide usage for malaria control on Anopheles funestus from Mozambique. Malar J 6: 142.[Crossref] [Google Scholar]
  42. Cuamba N, Morgan JC, Irving H, Steven A, Wondji CS, , 2010. High level of pyrethroid resistance in an Anopheles funestus population of the Chokwe District in Mozambique. PLoS ONE 5: e11010.[Crossref] [Google Scholar]
  43. Hargreaves K, Koekemoer LL, Brooke BD, Hunt RH, Mthembu J, Coetzee M, , 2000. Anopheles funestus resistant to pyrethroid insecticides in South Africa. Med Vet Entomol 14: 181189.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 06 Oct 2011
  • Accepted : 03 Mar 2012
  • Published online : 01 Jun 2012

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