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                          enGender Impact: The World Bank’s Gender Impact Evaluation Database



   Evaluating indoor residual spray for reducing malaria infection prevalence in Eritrea: Results from a
                                       community randomized trial
               Joseph Keating, Andrea Locatelli, Andemariam Gebremichael, Tewolde Ghebremeskel, Jacob Mufunda, Selam
 Author(s)
               Mihreteab, Daniel Berhane, Pedro Carneiro
  Contact      jkeating@tulane.edu

  Country      Eritrea
Organizing
               Health
 Theme
   Status      Completed
Intervention
             Malaria Control
  Category
  Sector       Health, Nutrition & Population
               This paper examines the relationship between indoor residual spray (IRS) and malaria parasite infection in Gash Barka
               Zone, Eritrea, an area with near universal coverage of insecticide treated bednets (ITN) and already low malaria parasite
               prevalence. A community randomized control trial was conducted in 2009. Malaria parasite infection prevalence was
               0.5% [95% confidence interval (CI): 0.37–0.78%], with no significant difference detected between treatment and
               control areas. ITN possession remains high, with over 70% of households reporting ITN ownership [95% CI: 68.4–
               72.9]. ITN use among individuals within ITN-owning households was just under half [46.7% (95% CI: 45.4–48.0)].
               Slight differences in ITN possession and use were detected between treatment and control areas. There was no
 Abstract      significant difference in malaria parasite infection prevalence among individuals in households with ≥1 ITN compared
               to those in households without ITNs, nor among individuals reporting ITN use. Among individuals in ITN-owning
               households, sleeping under an ITN offered no statistically significant protection from malaria parasite infection.
               Community participation in environmental and larval habitat management activities was low: 17.9% (95% CI: 16.0–
               19.7). It is likely that IRS, larval habitat management and ITN distribution alone may be insufficient to interrupt
               transmission without corresponding high ITN use, sustained IRS application in areas where infections are clustered,
               and promptly seeking laboratory diagnosis and treatment of all fevers. Eritrea is ready for elimination, irrespective of
               inconclusive impact evaluation results.
 Gender
               Gender Informed Analysis
Connection
 Gender
               Use of healthcare services
Outcomes
 IE Design     Clustered Randomized Control Trial (Clustered at village level)
               The intervention involved the control of adult mosquito populations using Indoor Residual Spray with the insecticide
Intervention
               DDT. The spray targeted all households in a village.
Intervention
               June- July 2009
   Period
  Sample       The sample was drawn from 58 treatment and 58 control villages in Gash Barka Zone. A random sample of 15 houses
 population    was selected in each village. There were 870 households in each the treatment and control.
Comparison     58 villages in Gash Barka Zone were randomly assigned treatment and 58 villages were randomly assigned as the
 conditions    control group and received other malaria prevention service, but not Indoor Residual Spray.
  Unit of
               Household Level
  analysis



             Last updated: 14 August 2013                                                                      1
                           enGender Impact: The World Bank’s Gender Impact Evaluation Database


Evaluation
                October, 2009
 Period
                There was no difference in parasite infection in treatment and control village. The prevalence of malaria parasite
                infection was twice as high for younger individuals in both treatment and control villages. There was no significant
  Results
                difference in malaria infection of individuals living with or without an insecticide treated net. Individuals who did not
                receive the treatment may have benefited from treatment in other households.
  Primary       The study design was post-test only and may have failed to capture important pre-test differences. Since the rate of
    study       malaria is so low, very large sample sizes are needed to detect impact. The data was collected at the end of peak malaria
limitations     transmission season possibly biasing the results downwards,
  Funding
                World Bank grant as par of HAMSET II
   Source
             Keating, J., Locatelli, A., Gebremichael, A., Ghebremeskel, T., Mufunda, J., Mihreteab, S., ... & Carneiro, P. (2011).
Reference(s) Evaluating indoor residual spray for reducing malaria infection prevalence in Eritrea: Results from a community
             randomized control trial. Acta tropica, 119(2), 107-113.
  Link to
  Studies    http://www.mcd.org/mcdi/docs/AJTMHCombiningIRSandITN.pdf
 Microdata
             http://microdata.worldbank.org/index.php/catalog/290http://microdata.worldbank.org/index.php/catalog/290




              Last updated: 14 August 2013                                                                      2