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Combining Indoor Residual Spraying and Insecticide-Treated Net Interventions

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  • 1 London School of Hygiene and Tropical Medicine, London, United Kingdom; Medical Care Development International, Silver Spring, Maryland; Global Malaria Programme, World Health Organization, Geneva, Switzerland; Ministerio de Sanidad y Bienestar Social, Malabo, República de Guinea Ecuatorial; Ministerio da Saude, Maputo, Mozambique; Malaria Research Programme, South African Medical Research Council, Durban, South Africa; Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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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.

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