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Malaria is a significant threat to health globally, affecting more than 200 million people and causing nearly 700,000 deaths per year. In spite of significant global declines in new cases and deaths since 2000, the greatest burden continues to be in children living in Africa. Vector control efforts, a critical component of malaria control in Africa and elsewhere, are threatened by mosquito resistance to current insecticides used in long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) methods – the two major vector control interventions currently in use.  TRAction is leading the way in researching innovative strategies to prevent malaria transmission and ongoing efforts are designed to test the efficacy and cost-effectiveness of vector control tools. New technologies such as durable insecticide-treated wall liners (DLs) offer promising alternatives to IRS and LLINs for areas with insecticide resistance. The National Institute for Medical Research (NIMR), in collaboration with the Kilimanjaro Christian Medical College and London School of Hygiene and Tropical Medicine, is currently conducting research on insecticide-treated durable wall lining (DL) as a novel vector control measure in the Muheza and Handeni districts of the Tanga region of Tanzania. Findings from this study will contribute to best practices in malaria prevention programming and may help inform national and local level decision-making by policymakers.  In the past, TRAction funded a study in Muleba District Tanzania to investigate whether high coverage of long-lasting insecticide-treated bednets (LLINs) reduced the need for indoor residual spraying of insecticides (IRS). The research aimed to determine whether the use of LLINs alone is equally effective as the combined use of IRS plus LLINs.

Key Results

TRAction's current project is currently in the data collection phase and results are forthcoming.  TRAction's past study yielded significant results concerning the efficacy of LLINs and IRS used in combination.  This is the first randomised trial to our knowledge that provides evidence that IRS, when used in combination with LLINs, can give significant added protection against malarial infection compared to LLIN use alone. There were several key outcomes from the research that highlight the importance of the study:
  • Exposure to infectious mosquito bites was about one-sixth in communities with the combined intervention compared to those in the LLIN only arm.
  • The primary outcome, prevalence of the malaria parasite (Plasmodium falciparum), was lower in the intervention arm in all three surveys conducted.
  • Prevalence of moderate to severe anemia in children under 5 years, a secondary outcome, was lower in the intervention arm in all post-intervention surveys.
The findings from this study suggest that national malaria control programs should consider implementing IRS in combination with LLINs if local LLIN strategies alone are insufficiently effective and cannot be improved.

Our Partners

  • London School of Hygiene and Tropical Medicine
  • National Institute of Medical Research
  • Kilimanjaro Christian Medical College


Publications Featuring TRAction Research 


Collaborative Efforts

Insecticide Treated Durable Wall Liners

Determining Effectiveness of Insecticide Treated Durable Wall Liners

The aim of this research is to assess the effectiveness of insecticide-treated durable wall liners (DL) for malaria control in Tanzania. The DL is a thin sheet of insecticide-treated woven shade cloth that is fixed to the inner walls of houses, covering the walls and open eaves. The purpose of this research is to assess the added benefit of DL used in combination with long-lasting insecticidal bednets (LLINs) compared to LLINs used alone. Data collected through this study will provide important information to the Tanzanian National Malaria Control Program (NMCP) and malaria-endemic countries to guide future malaria control efforts and allocation of resources.

Effectiveness of IRS and LLIN

Insecticide treated net in Tanzania, TRAction
Evaluating Effectiveness of IRS and LLIN

Insecticide treated nets (ITN) and indoor residual spraying (IRS) of houses provide effective malaria transmission control. There is conflicting evidence whether it is more beneficial to provide both interventions in combination.The London School of Hygiene and Tropical Medicine (LSHTM) conducted research to investigate whether the combination provides added protection compared to ITNs alone. In partnership with National Institute for Medical Research and Kilimanjaro Christian Medical College, LSHTM carried out a two arm randomized trial to determine the impact of ITNs and IRS on malaria transmission rates.

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