title: Indoor Residual Spraying Delivery Models to Prevent Malaria: Comparison of Community- and District-Based Approaches in Ethiopia.
abstract: Indoor residual spraying (IRS) for malaria prevention has traditionally been implemented in Ethiopia by the district health office with technical and operational inputs from regional, zonal, and central health offices. The United States President's Malaria Initiative (PMI) in collaboration with the Government of Ethiopia tested the effectiveness and efficiency of integrating IRS into the government-funded community-based rural health services program.
  
  
  
  Between 2012 and 2014, PMI conducted a mixed-methods study in 11 districts of Oromia region to compare district-based IRS (DB IRS) and community-based IRS (CB IRS) models. In the DB IRS model, each district included 2 centrally located operational sites where spray teams camped during the IRS campaign and from which they traveled to the villages to conduct spraying. In the CB IRS model, spray team members were hired from the communities in which they operated, thus eliminating the need for transport and camping facilities. The study team evaluated spray coverage, the quality of spraying, compliance with environmental and safety standards, and cost and performance efficiency.
  
  
  
  The average number of eligible structures found and sprayed in the CB IRS districts increased by 19.6% and 20.3%, respectively, between 2012 (before CB IRS) and 2013 (during CB IRS). Between 2013 and 2014, the numbers increased by about 14%. In contrast, in the DB IRS districts the number of eligible structures found increased by only 8.1% between 2012 and 2013 and by 0.4% between 2013 and 2014. The quality of CB IRS operations was good and comparable to that in the DB IRS model, according to wall bioassay tests. Some compliance issues in the first year of CB IRS implementation were corrected in the second year, bringing compliance up to the level of the DB IRS model. The CB IRS model had, on average, higher amortized costs per district than the DB IRS model but lower unit costs per structure sprayed and per person protected because the community-based model found and sprayed more structures.
  
  
  
  Established community-based service delivery systems can be adapted to include a seasonal IRS campaign alongside the community-based health workers' routine activities to improve performance efficiency. Further modifications of the community-based IRS model may reduce the total cost of the intervention and increase its financial sustainability.
authors.affiliation: Abt Associates, Inc., The President's Malaria Initiative Africa Indoor Residual Spraying Project, Bethesda, MD, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Johns
authors.affiliation: Abt Associates, Inc., The President's Malaria Initiative Africa Indoor Residual Spraying Project, Addis Ababa, Ethiopia.
authors.forename: Yemane Yeebiyo
authors.initials: YY
authors.lastname: Yihdego
authors.affiliation: Abt Associates, Inc., The President's Malaria Initiative Africa Indoor Residual Spraying Project, Bethesda, MD, USA. lena_kolyada@abtassoc.com.
authors.forename: Lena
authors.initials: L
authors.lastname: Kolyada
authors.affiliation: Abt Associates, Inc., The President's Malaria Initiative Africa Indoor Residual Spraying Project, Bethesda, MD, USA.
authors.forename: Dereje
authors.initials: D
authors.lastname: Dengela
authors.affiliation: U.S. President's Malaria Initiative, U.S. Agency for International Development, Addis Ababa, Ethiopia.
authors.forename: Sheleme
authors.initials: S
authors.lastname: Chibsa
authors.affiliation: U.S. President's Malaria Initiative, U.S. Agency for International Development, Addis Ababa, Ethiopia.
authors.forename: Gunawardena
authors.initials: G
authors.lastname: Dissanayake
authors.affiliation: U.S. President's Malaria Initiative, U.S. Agency for International Development, Bureau for Global Health, Office of Health, Infectious Disease & Nutrition, Arlington, VA, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: George
authors.affiliation: National Malaria Control Program, Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Hiwot Solomon
authors.initials: HS
authors.lastname: Taffese
authors.affiliation: Abt Associates, Inc., The President's Malaria Initiative Africa Indoor Residual Spraying Project, Bethesda, MD, USA.
authors.forename: Bradford
authors.initials: B
authors.lastname: Lucas
mesh_terms: D003153:Community Health Services / Q000379:methods*; D005002:Ethiopia; D006801:Humans; D007306:Insecticides / Q000008:administration & dosage*; D008288:Malaria / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods*; D012424:Rural Population / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D007306:Insecticides