{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T18:16:36Z","timestamp":1783361796545,"version":"3.54.6"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Indoor residual spraying (IRS) and insecticide treated bed nets (ITNs) used either singly or in combination are the main mass mosquito vector control measures for malaria control. Despite their widespread use, malaria transmission rates remain high, the burden is unacceptably huge, and yet the disease is completely preventable. This study measured the impact of compounds used in different types and campaigns of IRS and ITNs, different permutations of IRS\u2009+\u2009ITNs on malaria test positivity rates in high disease transmission settings of Yumbe district and Gulu district.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      The Ministry of Health\u2019s District Health Information System 2 (DHIS 2) records on distribution of ITNs, IRS schedules and malaria cases by gender, age and geographical location (Gulu and Yumbe districts) collected over a five-year period (DHIS 2 records accessed on 11\n                      <jats:sup>th<\/jats:sup>\n                      February 2025) were used in the final analysis. Data collection was done using a checklist developed in an Excel spreadsheet. Data on the following were extracted; socio-demographic characteristics, number of monthly malaria tests, monthly numbers of positive malaria tests, the type of Insecticide Treated Nets (ITNs) distributed, the type of Indoor Residual Spray (IRS) applied and the time points that the interventions were deployed. The data was exported into STATA ver 17.0,cleaned and additional variables generated prior to the interrupted time series and Difference in Difference analysis. The monthly malaria test positivity rate (TPR) was calculated while adjusting for variability in rainfall, temperature and relative humidity. A regression analysis and graphical plots using the Generalized Estimation Equation (GEE) population average models were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After controlling for monthly variation in rainfall, temperature, and relative humidity, the deployment of malaria vector control interventions in Yumbe district led to a much faster reduction in TPR of 0.006 units\/0.56% per month; p\u2009&lt;\u20090.00 (about 5 times faster than Gulu district). The 2020 distribution of Yorkool ITNs in Yumbe did not significantly change the long-term trend in TPR of the district relative to Gulu that maintained distribution of PermaNets ITN (trend change difference\u2009=\u20090.0111, beta\u2009=\u2009\u22120.0054, 95% CI:0.1145, 0.1038, p\u2009=\u20090.923). Fludora Fusion demonstrated a profound impact. The difference-in-differences interaction term was highly statistically significant, showing an absolute 21.2% drop in the Malaria Test Positivity Rate in Yumbe District relative to Gulu district (beta\u2009=\u2009\u22120.2123, 95% CI: \u22120.2801, \u22120.1444, p\u2009&lt;\u20090.001). Following a co-deployment of Actellic 300 CS IRS+ Royal Guard ITNs in Yumbe and distribution of PermaNet ITNs in Gulu, the difference-in-differences interaction term was highly statistically significant, demonstrating an absolute 25.1% drop in the Malaria Test Positivity Rate in Yumbe District compared to Gulu district (beta\u2009=\u2009\u22120.2508, 95%CI:-0.3279, \u22120.1737,p\u2009&lt;\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In areas of high malaria transmission, deployment of either ITNs alone, IRS alone, or in combination can be an effective tool for malaria case reduction. However, a more sustained and significant reduction is achieved through the simultaneous deployment of IRS and ITNs. Crucially, the efficacy of these combined interventions is highly shaped by the specific classes of insecticides and active compounds utilized within the deployed ITN types and IRS campaigns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0352455","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T17:37:25Z","timestamp":1783359445000},"page":"e0352455","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combination of different intervention strategies for malaria mosquito vector control in Uganda: A review of secondary data of two districts with moderate to high disease transmission"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2836-7141","authenticated-orcid":true,"given":"Erick Jacob","family":"Okek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winnie","family":"Nambatya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loyce","family":"Nakalembe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Awor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1211-4617","authenticated-orcid":true,"given":"Benson","family":"Musinguzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amos","family":"Drasiku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sande James","family":"Obondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Lukindu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Lutwama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Kayondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Ocan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"issue":"10","key":"pone.0352455.ref001","doi-asserted-by":"crossref","DOI":"10.1016\/S2542-5196(24)00172-4","article-title":"Malaria vector control in sub-Saharan Africa: complex trade-offs to combat the growing threat of insecticide resistance","volume":"8","author":"RM Oxborough","year":"2024","journal-title":"Lancet Planet Health"},{"key":"pone.0352455.ref002","volume-title":"World malaria report 2023: World Health Organization","author":"Organization WH","year":"2023"},{"issue":"1","key":"pone.0352455.ref003","doi-asserted-by":"crossref","first-page":"008","DOI":"10.17352\/apm.000032","article-title":"The effectiveness of interventions for improving the uptake of Intermittent Preventive Treatment (IPT) for malaria control among pregnant women in sub-saharan Africa: A systematic literature review","volume":"8","author":"E Chukwuma Ernest","year":"2023","journal-title":"Arch Prev Med"},{"issue":"3","key":"pone.0352455.ref004","doi-asserted-by":"crossref","first-page":"546","DOI":"10.3390\/ijerph15030546","article-title":"A meta-regression analysis of the effectiveness of mosquito nets for malaria control: the value of long-lasting insecticide nets","volume":"15","author":"G-G Yang","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"pone.0352455.ref005","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2024-017106","article-title":"Evaluating the impact of two next-generation long-lasting insecticidal nets on malaria incidence in Uganda: an interrupted time-series analysis using routine health facility data","volume":"10","author":"A Epstein","year":"2025","journal-title":"BMJ Glob Health"},{"issue":"1","key":"pone.0352455.ref006","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1186\/s12889-021-11062-7","article-title":"Long lasting insecticidal mosquito nets (LLINs) ownership, use and coverage following mass distribution campaign in Lake Victoria basin, Western Kenya","volume":"21","author":"PN Ng\u2019ang\u2019a","year":"2021","journal-title":"BMC Public Health"},{"key":"pone.0352455.ref007","article-title":"Insecticide-treated nets for malaria control: real gains","author":"C Lengeler","year":"2004","journal-title":"SciELO Public Health"},{"issue":"1","key":"pone.0352455.ref008","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1186\/s12936-023-04753-6","article-title":"Mass distribution campaign of long-lasting insecticidal nets (LLINs) during the COVID-19 pandemic in Uganda: lessons learned","volume":"22","author":"HB Aguma","year":"2023","journal-title":"Malar J"},{"issue":"1","key":"pone.0352455.ref009","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12936-016-1652-4","article-title":"Assessing the effect of indoor residual spraying (IRS) on malaria morbidity in Northern Uganda: a before and after study","volume":"16","author":"BB Tukei","year":"2017","journal-title":"Malar J"},{"issue":"1","key":"pone.0352455.ref010","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1038\/s41467-021-22896-5","article-title":"The impact of stopping and starting indoor residual spraying on malaria burden in Uganda","volume":"12","author":"JF Namuganga","year":"2021","journal-title":"Nat Commun"},{"issue":"8","key":"pone.0352455.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003254","article-title":"Dramatic resurgence of malaria after 7 years of intensive vector control interventions in Eastern Uganda","volume":"4","author":"MR Kamya","year":"2024","journal-title":"PLOS Glob Public Health"},{"key":"pone.0352455.ref012","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/1475-2875-10-208","article-title":"Combining indoor residual spraying and insecticide-treated nets for malaria control in Africa: a review of possible outcomes and an outline of suggestions for the future","volume":"10","author":"FO Okumu","year":"2011","journal-title":"Malar J"},{"issue":"1","key":"pone.0352455.ref013","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s12879-023-07991-w","article-title":"Impact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin-piperaquine on malaria prevalence in a high transmission setting: a quasi-experimental controlled before-and-after trial in northeastern Uganda","volume":"23","author":"DC Echodu","year":"2023","journal-title":"BMC Infect Dis"},{"issue":"8","key":"pone.0352455.ref014","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/S1473-3099(12)70081-6","article-title":"Combination of malaria vector control interventions in pyrethroid resistance area in Benin: a cluster randomised controlled trial","volume":"12","author":"V Corbel","year":"2012","journal-title":"Lancet Infect Dis"},{"key":"pone.0352455.ref015","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/1475-2875-5-33","article-title":"A steep decline of malaria morbidity and mortality trends in Eritrea between 2000 and 2004: the effect of combination of control methods","volume":"5","author":"PM Nyarango","year":"2006","journal-title":"Malar J"},{"issue":"1","key":"pone.0352455.ref016","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2024-016617","article-title":"An observational study evaluating the epidemiological and entomological impacts of piperonyl butoxide insecticide-treated nets (ITNs) compared to a combination of indoor residual spraying (IRS) plus standard pyrethroid-only ITNs in Amhara Region, Ethiopia, 2019\u20132023","volume":"10","author":"KM Davis","year":"2025","journal-title":"BMJ Global Health"},{"issue":"10","key":"pone.0352455.ref017","first-page":"475","article-title":"Long-lasting insecticide-treated nets combined or not with indoor residual spraying may not be sufficient to eliminate malaria: a case-control study, Benin, West Africa","volume":"8","author":"BG Damien","year":"2023","journal-title":"Trop Med Infect Dis"},{"key":"pone.0352455.ref018","unstructured":"Wilderness Explorers Africa Ltd. Vegetation of Uganda. https:\/\/wildernessexplorersafrica.com\/african-safari-destinations\/uganda-safaris-tours-holidays\/vegetation-uganda\/"},{"issue":"1","key":"pone.0352455.ref019","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1186\/s12936-024-05184-7","article-title":"Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda","volume":"23","author":"S Oguta","year":"2024","journal-title":"Malar J"},{"issue":"4","key":"pone.0352455.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0283755","article-title":"High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study","volume":"18","author":"C Mangusho","year":"2023","journal-title":"PLoS One"},{"issue":"1","key":"pone.0352455.ref021","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/s40249-022-01005-8","article-title":"Effectiveness of indoor residual spraying on malaria control: a systematic review and meta-analysis","volume":"11","author":"Y Zhou","year":"2022","journal-title":"Infect Dis Poverty"},{"issue":"4","key":"pone.0352455.ref022","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.4269\/ajtmh.20-0250","article-title":"Malaria transmission, infection, and disease following sustained indoor residual spraying of insecticide in Tororo, Uganda","volume":"103","author":"JI Nankabirwa","year":"2020","journal-title":"Am J Trop Med Hygiene"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0352455","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T17:37:36Z","timestamp":1783359456000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0352455"}},"subtitle":[],"editor":[{"given":"Jan","family":"Rycht\u00e1\u0159","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":22,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,6]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0352455","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]}}}