{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T12:38:31Z","timestamp":1783946311496,"version":"3.55.0"},"reference-count":53,"publisher":"National Academy of Sciences","issue":"16","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"HHS | NIH | National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01 AI163398"],"award-info":[{"award-number":["R01 AI163398"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.pnas.org"],"crossmark-restriction":true},"short-container-title":["Proc. Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2025,4,22]]},"abstract":"<jats:p>\n                    Indoor residual spraying (IRS) is one of the core vector control interventions available to malaria control programs. Normative and scientific guidance has long held that very high IRS coverage (at least 80 to 85% houses sprayed) is necessary to provide community protection, but there is little evidence backing these recommendations, in large part due to the operational and ethical concerns that conducting appropriate trials of differing IRS coverage levels would raise. The present study leverages data from four years of targeted IRS implementation on Bioko Island, Equatorial Guinea, to estimate a dose\u2013response curve of IRS coverage. Due to the observational nature of the data, a double robust causal inference technique was utilized. The results suggest that at all spatial scales examined a threshold providing community protection was reached at much lower coverage levels than previously assumed (30 to 50%). Sensitivity analysis corroborated this result across multiple methods, but there was less agreement on whether extremely high coverage (\n                    <jats:inline-formula>\n                      <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" overflow=\"scroll\">\n                        <mml:mo>\u2265<\/mml:mo>\n                      <\/mml:math>\n                    <\/jats:inline-formula>\n                    85%) has additional benefit. A secondary analysis of the impact of changing operational coverage targets found that significantly reducing coverage targets (to 30 to 60%) could provide nearly the same protection as maintaining the existing 80% target in Bioko. While these findings are limited in strength by the observational nature of the data and may be specific to the context of Bioko Island, they raise important questions for further research on how IRS coverage impacts epidemiological outcomes and on how malaria control programs should set programmatic IRS coverage targets.\n                  <\/jats:p>","DOI":"10.1073\/pnas.2421531122","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T15:00:31Z","timestamp":1744642831000},"update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":8,"title":["Reconsidering indoor residual spraying coverage targets: A retrospective analysis of high-resolution programmatic malaria control data"],"prefix":"10.1073","volume":"122","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3028-7650","authenticated-orcid":false,"given":"David S.","family":"Galick","sequence":"first","affiliation":[{"name":"MCD Global Health","place":["Malabo, Equatorial Guinea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liberato Motobe","family":"Vaz","sequence":"additional","affiliation":[{"name":"MCD Global Health","place":["Malabo, Equatorial Guinea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Ondo","sequence":"additional","affiliation":[{"name":"MCD Global Health","place":["Malabo, Equatorial Guinea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos Mbulito","family":"Iyanga","sequence":"additional","affiliation":[{"name":"MCD Global Health","place":["Malabo, Equatorial Guinea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faustino Etoho Ebang","family":"Bikie","sequence":"additional","affiliation":[{"name":"MCD Global Health","place":["Malabo, Equatorial Guinea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Restituto Mba Nguema","family":"Avue","sequence":"additional","affiliation":[{"name":"MCD Global Health","place":["Malabo, Equatorial Guinea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier Tresor","family":"Donfack","sequence":"additional","affiliation":[{"name":"MCD Global Health","place":["Malabo, Equatorial Guinea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerem\u00edas Nzam\u00edo Mba","family":"Eyono","sequence":"additional","affiliation":[{"name":"MCD Global Health","place":["Malabo, Equatorial Guinea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa Ayingono","family":"Ondo Mifumu","sequence":"additional","affiliation":[{"name":"MCD Global Health","place":["Malabo, Equatorial Guinea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianna E. B.","family":"Hergott","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation","place":["Seattle"]},{"name":"University of Washington","place":["Seattle"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wonder P.","family":"Phiri","sequence":"additional","affiliation":[{"name":"MCD Global Health","place":["Malabo, Equatorial Guinea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4367-3849","authenticated-orcid":false,"given":"David L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation","place":["Seattle"]},{"name":"University of Washington","place":["Seattle"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4069-9528","authenticated-orcid":false,"given":"Carlos A.","family":"Guerra","sequence":"additional","affiliation":[{"name":"MCD Global Health","place":["Silver Spring"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo A.","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"MCD Global Health","place":["Silver Spring"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"e_1_3_4_1_2","unstructured":"World Health Organization Interim Commission \u201cExpert committee on malaria: Report on the first session\u201d (Tech. 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Malaria transmission after five years of vector control on Bioko Island Equatorial Guinea. Parasit. Vectors 5 253 (2012).","DOI":"10.1186\/1756-3305-5-253"},{"key":"e_1_3_4_38_2","doi-asserted-by":"crossref","unstructured":"E. Sherrard-Smith et al. Mosquito feeding behavior and how it influences residual malaria transmission across Africa. Proc. Natl. Acad. Sci. U.S.A. 116 15086\u201315095 (2019).","DOI":"10.1073\/pnas.1820646116"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/biom.13745"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.2020.1768100"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.2021.1955691"},{"key":"e_1_3_4_42_2","doi-asserted-by":"crossref","unstructured":"G. A. Garc\u00eda et al. Mapping and enumerating houses and households to support malaria control interventions on Bioko Island. Malar. 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