The Effect of Indoor Residual Spraying on Malaria and Anemia in a High-Transmission Area of Northern Uganda

Laura C. Steinhardt Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Programme, Ministry of Health, Kampala, Uganda; Makerere University, Kampala, Uganda; University of California, San Francisco, California; The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland

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Adoke Yeka Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Programme, Ministry of Health, Kampala, Uganda; Makerere University, Kampala, Uganda; University of California, San Francisco, California; The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland

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Sussann Nasr Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Programme, Ministry of Health, Kampala, Uganda; Makerere University, Kampala, Uganda; University of California, San Francisco, California; The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland

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Ryan E. Wiegand Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Programme, Ministry of Health, Kampala, Uganda; Makerere University, Kampala, Uganda; University of California, San Francisco, California; The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland

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Denis Rubahika Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Programme, Ministry of Health, Kampala, Uganda; Makerere University, Kampala, Uganda; University of California, San Francisco, California; The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland

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Asadu Sserwanga Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Programme, Ministry of Health, Kampala, Uganda; Makerere University, Kampala, Uganda; University of California, San Francisco, California; The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland

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Humphrey Wanzira Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Programme, Ministry of Health, Kampala, Uganda; Makerere University, Kampala, Uganda; University of California, San Francisco, California; The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland

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Geoff Lavoy Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Programme, Ministry of Health, Kampala, Uganda; Makerere University, Kampala, Uganda; University of California, San Francisco, California; The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland

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Moses Kamya Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Programme, Ministry of Health, Kampala, Uganda; Makerere University, Kampala, Uganda; University of California, San Francisco, California; The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland

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Grant Dorsey Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Programme, Ministry of Health, Kampala, Uganda; Makerere University, Kampala, Uganda; University of California, San Francisco, California; The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland

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Scott Filler Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Programme, Ministry of Health, Kampala, Uganda; Makerere University, Kampala, Uganda; University of California, San Francisco, California; The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland

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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%, P < 0.001. Anemia prevalence was also significantly lower in the two IRS districts: 38.8% and 36.8% versus 53.0%, P < 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 (P < 0.001). Carefully managed IRS can significantly reduce malaria burden in high-transmission settings.

Author Notes

* Address correspondence to Laura C. Steinhardt, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE, Atlanta, GA 30333. E-mail: LSteinhardt@cdc.gov

Financial support: This study was funded by the President's Malaria Initiative (PMI).

Authors' addresses: Laura C. Steinhardt and Ryan E. Wiegand, Centers for Disease Control and Prevention (CDC), Atlanta, GA, E-mails: LSteinhardt@cdc.gov and RWiegand@cdc.gov. Adoke Yeka, Asadu Sserwanga, Humphrey Wanzira, Geoff Lavoy, and Moses Kamya, Uganda Malaria Surveillance Project (UMSP), Kampala, Uganda, E-mails: yadoke@muucsf.org, asserwanga@muucsf.org, wanzirah@yahoo.com, glavoy@muucsf.org, and mkamya@infocom.co.ug. Sussann Nasr, Centers for Disease Control and Prevention—Angola, Luanda, Angola, E-mail: Snasr@usaid.gov. Dennis Rubahika, Uganda National Malaria Control Programme, Kamapala, Uganda, E-mail: drubahika@yahoo.com. Grant Dorsey, University of California, San Francisco, CA, E-mail: gdorsey@medsfgh.ucsf.edu. Scott Filler, The Global Fund to Fight AIDS, Tuberculosis, and Malaria. Geneva, Switzerland, E-mail: Scott.Filler@theglobalfund.org.

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