title: Indoor residual spraying of insecticide and malaria morbidity in a high transmission intensity area of 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.
  
  
  RESULTS
  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 1(st) round of IRS using DDT (OR = 0.76, p<0.001) and the 2(nd) 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
  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.
authors.affiliation: Uganda Malaria Surveillance Project, Kampala, Uganda.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kigozi
authors.forename: Sanjiv M
authors.initials: SM
authors.lastname: Baxi
authors.forename: Anne
authors.initials: A
authors.lastname: Gasasira
authors.forename: Asadu
authors.initials: A
authors.lastname: Sserwanga
authors.forename: Stella
authors.initials: S
authors.lastname: Kakeeto
authors.forename: Sussann
authors.initials: S
authors.lastname: Nasr
authors.forename: Denis
authors.initials: D
authors.lastname: Rubahika
authors.forename: Gunawardena
authors.initials: G
authors.lastname: Dissanayake
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
authors.forename: Scott
authors.initials: S
authors.lastname: Filler
authors.forename: Grant
authors.initials: G
authors.lastname: Dorsey
mesh_terms: D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007306:Insecticides / Q000633:toxicity*; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D009017:Morbidity; D009032:Mosquito Control; D012621:Seasons; D013997:Time Factors; D014454:Uganda / Q000453:epidemiology
chemical_list: D007306:Insecticides