ArticleBMC global and public health2026
Impact of indoor residual spraying and insecticide-treated nets on malaria burden in 8 districts in West Nile and Acholi regions, Uganda: a quasi-experimental study.
Article in BMC global and public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn Uganda, where malaria transmission is high, insecticide treated nets (ITNs) have been distributed nationwide every 3 years since 2013. In West Nile, northern Uganda, indoor residual spraying (IRS) was first implemented with clothianidin-deltamethrin (Fludora Fusion®) in 2022, followed by pirimiphos-methyl (Actellic® 300CS) in 2023. We utilised a quasi-experimental study to assess the impact of IRS + ITNs on malaria incidence in West Nile.
methodsData were collected from three malaria reference centres (MRCs) in West Nile (IRS + ITNs, intervention) and five MRCs in neighbouring Acholi (ITNs only, control) over 4 years: (1) Baseline (December 2020-November 2022), prior to IRS; (2) IRS-1 (December 2022-December 2023) following IRS with clothianidin-deltamethrin; (3) IRS-2 (January 2024-December 2024) following IRS with pirimiphos-methyl. The primary outcome was monthly malaria incidence from each MRC target area per 1000 person-years. Data were analysed using negative binomial regression models with a difference-in-difference approach, comparing pre-post trends in malaria incidence between arms. Adjusted models accounted for 2-month lagged rainfall and seasonality.
resultsDuring IRS-1, mean observed malaria incidence fell from baseline in both arms (intervention: 720.9 to 547.9; and control: 523.4 to 455.2 per 1000 person-years). We detected a 15% difference in predicted mean incidence between arms during IRS-1 relative to baseline, but this was not significant (adjusted incidence rate ratio (aIRR) = 0.85, 95% confidence interval (CI) 0.69-1.04, p = 0.11). During IRS-2, incidence in the intervention arm declined by 79.3% compared to baseline (720.9 to 149.1), and by 24.3% (523.4 to 396.2) in the control arm. We detected a 73% reduction in predicted mean malaria incidence in the intervention arm compared to control relative to baseline (aIRR = 0.27, 95% CI 0.22-0.34, p < 0.001). During IRS-2, there was strong evidence of an immediate and sustained reduction in incidence in the intervention arm over 1 year.
conclusionsIn West Nile, the reduction in malaria incidence after clothianidin-based IRS (plus ITNs) was modest and non-significant. Subsequent IRS with pirimiphos-methyl (plus ITNs) substantially reduced malaria incidence. These results highlight the importance of selecting context-specific insecticides for vector control programmes and the potential synergistic effect of dual interventions in areas of high pyrethroid resistance.
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