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Indoor residual spraying of insecticide and malaria morbidity in a high transmission intensity area of Uganda
Authors:Ruth Kigozi  Sanjiv M Baxi  Anne Gasasira  Asadu Sserwanga  Stella Kakeeto  Sussann Nasr  Denis Rubahika  Gunawardena Dissanayake  Moses R Kamya  Scott Filler  Grant Dorsey
Affiliation:Uganda Malaria Surveillance Project, Kampala, Uganda.
Abstract:

Background

Recently 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 Findings

Routine 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/Significance

IRS 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.
Keywords:
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