Abstract
BackgroundRecently the use of indoor residual spraying of insecticide (IRS) has greatly increased in Africa; however, limited data exist on the quantitative impacts of IRS on health outcomes in highly malaria endemic areas.Methodology/Principal FindingsRoutine data were collected on more than 90,000 patient visits at a single health facility over a 56 month period covering five rounds of IRS using three different insecticides. Temporal associations between the timing of IRS and the probability of a patient referred for microscopy having laboratory confirmed malaria were estimated controlling for seasonality and age. Considering patients less than five years of age there was a modest decrease in the odds of malaria following the 1st round of IRS using DDT (OR = 0.76, p<0.001) and the 2nd round using alpha-cypermethrin (OR = 0.83, p = 0.002). Following rounds 3–5 using bendiocarb there was a much greater decrease in the odds of malaria (ORs 0.34, 0.16, 0.17 respectively, p<0.001 for all comparisons). Overall, the impact of IRS was less pronounced among patients 5 years or older.Conclusions/SignificanceIRS was associated with a reduction in malaria morbidity in an area of high transmission intensity in Uganda and the benefits appeared to be greatest after switching to a carbamate class of insecticide.
Highlights
Malaria is a leading cause of morbidity and mortality in Uganda with an estimated 8–13 million cases per year accounting for 30– 50% of outpatient visits, 35% of hospital admissions and 9–14% of hospital deaths, with nearly half of those in children less than 5 years of age [1]
Indoor residual spraying of insecticide (IRS) has played an important role in the prevention of malaria and more recently, several countries in sub-Saharan Africa have added IRS as part of their malaria control plan in line with the Global Malaria Action Plan launched by the WHO-Roll Back Malaria Partnership [2]
Among patients with complete data, less than 1% reported residing outside the Apac district where IRS was conducted and 57% reported residing in the Aduku sub-county where the sentinel site health facility was located
Summary
Malaria is a leading cause of morbidity and mortality in Uganda with an estimated 8–13 million cases per year accounting for 30– 50% of outpatient visits, 35% of hospital admissions and 9–14% of hospital deaths, with nearly half of those in children less than 5 years of age [1]. Several historical reviews have documented programmatic benefits of successful IRS programs in Africa, primarily in the southern part of the continent [5,6,7,8,9,10] These reviews reported clear and substantial reductions in various malaria related outcomes and measures of vector density, and in some instances local elimination was achieved. Most of these studies lacked an appropriate control group needed to accurately quantify the impact of IRS. The use of indoor residual spraying of insecticide (IRS) has greatly increased in Africa; limited data exist on the quantitative impacts of IRS on health outcomes in highly malaria endemic areas
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