The Impact of Multiple Rounds of Indoor Residual Spraying on Malaria Incidence and Hemoglobin Levels in a High-Transmission Setting

Zinszer, Kate; Charland, Katia; Vahey, Sarah; Jahagirdar, Deepa; Rek, John; Arinaitwe, Emmanuel; Nankabirwa, Joaniter I.; Morrison, Kathryn; Sadoine, Margaux L.; Tutt-Guérette, Marc-Antoine; Staedke, Sarah G.; Kamya, Moses R.; Greenhouse, Bryan; Rodríguez-Barraquer, Isabel; Dorsey, Grant

doi:10.1093/infdis/jiz453

Cited by 17 publications

(25 citation statements)

References 29 publications

(34 reference statements)

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“…IRS was suspended in Apac in May 2014 [ 47 ], however one round of IRS with Actellic® was conducted in May 2017 [ 48 ]. In Tororo, biannual IRS with Bendiocarb began in December 2014 through 2015, in 2016 IRS involved annual spray rounds with Actellic® [ 49 ] and continued throughout the hospital surveillance period 2017–2018 (Table 1 ). Vector control in Mubende, Kabale and Jinja has relied only on Long-Lasting Insecticide treated Net (LLIN) distribution.…”

Section: Resultsmentioning

confidence: 99%

“…Since 2014, the traditionally high transmission (Table 1 ) region in Tororo, continues to be under intensive IRS (Table 1 ) [ 49 ], sustaining protection against infection among children aged 1 month to 4 years of age at-risk of hospitalisation with malaria during the 2017–2018 surveillance period. In Tororo children older than 5 years would have been exposed to high transmission intensity from birth (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

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The age-specific incidence of hospitalized paediatric malaria in Uganda

et al. 2020

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Background Understanding the relationship between malaria infection risk and disease outcomes represents a fundamental component of morbidity and mortality burden estimations. Contemporary data on severe malaria risks among populations of different parasite exposures are scarce. Using surveillance data, we compared rates of paediatric malaria hospitalisation in areas of varying parasite exposure levels. Methods Surveillance data at five public hospitals; Jinja, Mubende, Kabale, Tororo, and Apac were assembled among admissions aged 1 month to 14 years between 2017 and 2018. The address of each admission was used to define a local catchment population where national census data was used to define person-year-exposure to risk. Within each catchment, historical infection prevalence was assembled from previously published data and current infection prevalence defined using 33 population-based school surveys among 3400 children. Poisson regression was used to compute the overall and site-specific incidences with 95% confidence intervals. Results Both current and historical Plasmodium falciparum prevalence varied across the five sites. Current prevalence ranged from < 1% in Kabale to 54% in Apac. Overall, the malaria admission incidence rate (IR) was 7.3 per 1000 person years among children aged 1 month to 14 years of age (95% CI: 7.0, 7.7). The lowest rate was described at Kabale (IR = 0.3; 95 CI: 0.1, 0.6) and highest at Apac (IR = 20.3; 95 CI: 18.9, 21.8). There was a correlation between IR across the five sites and the current parasite prevalence in school children, though findings were not statistically significant. Across all sites, except Kabale, malaria admissions were concentrated among young children, 74% were under 5 years. The median age of malaria admissions at Kabale hospital was 40 months (IQR 20, 72), and at Apac hospital was 36 months (IQR 18, 69). Overall, severe anaemia (7.6%) was the most common presentation and unconsciousness (1.8%) the least common. Conclusion Malaria hospitalisation rates remain high in Uganda particularly among young children. The incidence of hospitalized malaria in different locations in Uganda appears to be influenced by past parasite exposure, immune acquisition, and current risks of infection. Interruption of transmission through vector control could influence age-specific severe malaria risk.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The age-specific incidence of hospitalized paediatric malaria in Uganda

et al. 2020

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“…Many barriers to LLIN use have been described, including many household members [36,37], lack of space to hang LLINs [38], lower socioeconomic status, and time since the last LLINs distribution [39]. In this study setting, where malaria transmission dropped substantially, individuals may have felt that it was no longer necessary to use their LLINs [5,28]. During travel, a possible barrier to LLIN adherence is limited availability of LLINs to use away from home.…”

Section: Discussionmentioning

confidence: 94%

“…In addition to IRS, LLINs were distributed to all households in Tororo through national campaigns in 2013 and 2017. The interventions have been associated with a drastic reduction in key malaria indicators, including malaria incidence, parasite prevalence and EIR which was <1% in 2018 [5,27,28].…”

Section: Study Sitementioning

confidence: 99%

“…Despite these achievements, malaria morbidity remains high worldwide; in 2018, 228 million malaria cases, 93% from Africa, were reported [1]. In Uganda, key malaria control strategies include prompt treatment with artemisinin-based combination therapy (ACTs), universal distribution of long-lasting insecticidal nets (LLINs), and targeted indoor residual spraying of insecticides (IRS) [2,[4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Association Between Recent Overnight Travel And Use Of Long-Lasting Insecticidal Nets In Rural Uganda: A Prospective Cohort Study In Tororo

Arinaitwe

Nankabirwa

Krezanoski

et al. 2020

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Background: The burden of malaria in Uganda remains high, but has become increasingly heterogenous following intensified malaria control. Travel within Uganda is recognised as a risk factor for malaria, but behaviours associated with travel are not well-understood. To address this knowledge gap, malaria-relevant behaviours of cohort participants were assessed during travel and at home in Uganda.Methods: Residents from 80 randomly selected households in Nagongera sub-county, Tororo district were enrolled into a cohort to study malaria in rural Uganda. All participants were given long-lasting insecticidal nets (LLINs) at enrolment and were evaluated every 4 weeks at the study clinic. Participants were asked if they had travelled overnight from their home, and if so, a questionnaire was administered to capture information on travel details and behaviours. Behaviour while at home was assessed using a similar questionnaire during two-weekly home visits. Behaviours while travelling vs at home were compared using generalized estimating equations adjusting for repeated measures in the same individual. Results: Between October 2017 and October 2019, 527 participants were enrolled and assessed for travel. Of these, 123 (23.2%) reported taking 211 overnight trips; 149 (70.6%) trips were within Tororo. Participants were less likely to use LLINs when travelling than when at home (41.0% vs. 56.2%, relative risk [RR] 0.73, 95% CI: 0.60-0.89, p=0.002); this difference was noted for women (38.8% vs 59.2%, RR 0.66, 95% CI 0.52-0.83, p=0.001) but not men (48.3% vs 46.6%, RR 0.96, 95% CI 0.67-1.40, p=0.85). In an adjusted analysis, factors associated with LLIN use when travelling included destination (travelling to districts not receiving indoor residual spraying [IRS] 65.8% vs Tororo district 32.2%, RR 1.80, 95% CI 1.31-2.46, p<0.001) and duration of travel (>7 nights 60.3% vs one night 24.4%, RR 1.97, 95% CI 1.07-3.64, p=0.03).Conclusions: Travellers, particularly women, were less likely to use LLINs when travelling than when at home. LLIN adherence was higher among those who travelled to non-IRS districts and for more than one week, suggesting that perceived malaria risk influences LLIN use. Strategies are needed to raise awareness of the importance of using LLINs while travelling.

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Indoor residual spraying for preventing malaria in communities using insecticide-treated nets

Pryce

Medley

Choi

2022

Cochrane Database of Systematic Reviews

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Background Insecticide‐treated nets (ITNs) and indoor residual spraying (IRS) are used to prevent malaria transmission. Both interventions use insecticides to kill mosquitoes that bite and rest indoors. Adding IRS to ITNs may improve malaria control simply because two interventions can be better than one. Furthermore, IRS may improve malaria control where ITNs are failing due to insecticide resistance. Pyrethroid insecticides are the predominant class of insecticide used for ITNs, as they are more safe than other insecticide classes when in prolonged contact with human skin. While many mosquito populations have developed some resistance to pyrethroid insecticides, a wider range of insecticides can be used for IRS. This review is an update of the previous Cochrane 2019 edition. Objectives To summarize the effect on malaria of additionally implementing IRS, using non‐pyrethroid‐like or pyrethroid‐like insecticides, in communities currently using ITNs. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register; CENTRAL; MEDLINE; and five other databases for records from 1 January 2000 to 8 November 2021, on the basis that ITN programmes did not begin to be implemented as policy before the year 2000. Selection criteria We included cluster‐randomized controlled trials (cRCTs), interrupted time series (ITS), or controlled before‐after studies (CBAs) comparing IRS plus ITNs with ITNs alone. We included studies with at least 50% ITN ownership (defined as the proportion of households owning one or more ITN) in both study arms. Data collection and analysis Two review authors independently assessed studies for eligibility, analyzed risk of bias, and extracted data. We used risk ratio (RR) and 95% confidence intervals (CI). We stratified by type of insecticide, 'pyrethroid‐like' and 'non‐pyrethroid‐like'; the latter could improve malaria control better than adding IRS insecticides that have the same way of working as the insecticide on ITNs ('pyrethroid‐like'). We used subgroup analysis of ITN usage in the studies to explore heterogeneity. We assessed the certainty of evidence using the GRADE approach. Main results Eight cRCTs (10 comparisons), one CBA, and one ITS study, all conducted since 2008 in sub‐Saharan Africa, met our inclusion criteria. The primary vectors in all sites were mosquitoes belonging to the Anopheles gambiae s.l. complex species; five studies in Benin, Mozambique, Ghana, Sudan, and Tanzania also reported the vector Anopheles funestus . Five cRCTs and both quasi‐experimental design studies used insecticides with targets different to pyrethroids (two used bendiocarb, three used pirimiphos‐methyl, and one used propoxur. Each of these studies were conducted in areas where the vectors were described as resistant or highly resistant to pyrethroids. Two...

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The Impact of Multiple Rounds of Indoor Residual Spraying on Malaria Incidence and Hemoglobin Levels in a High-Transmission Setting

Cited by 17 publications

References 29 publications

The age-specific incidence of hospitalized paediatric malaria in Uganda

The age-specific incidence of hospitalized paediatric malaria in Uganda

Association Between Recent Overnight Travel And Use Of Long-Lasting Insecticidal Nets In Rural Uganda: A Prospective Cohort Study In Tororo

Indoor residual spraying for preventing malaria in communities using insecticide-treated nets

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