![]() ![]() A true targeted approach would deliver IRS to sub-district areas identified as high-risk, with the goal of maximizing the prevention of malaria cases and deaths. To explore the feasibility of doing so, PMI, in collaboration with the National Malaria Elimination Centre, recently commissioned a comparison-control trial to evaluate different prioritization strategies. However, the country’s increased emphasis on universal coverage of long-lasting insecticidal nets and effective insecticide resistance management has spurred a desire to shift towards a more strategic and targeted approach for IRS resources. The available funding has been sufficient to spray around 50% of the houses in the eastern half of the country. In Zambia, IRS has typically been implemented over large areas, e.g., district-wide, and targeted to peri-urban areas. David Larsen of the University of Syracuse frames it, “With insufficient funding to spray all houses, the cost of spraying any house carries an opportunity cost of not spraying a different house.” So how do we choose? A difficult, but honest question we’re confronted with each year when funding PMI focus country programs is: If we cannot spray all houses at risk of malaria transmission, which houses should we spray? Or as researcher Dr. It is a powerful intervention in the fight against malaria, but its high cost prohibits most national malaria programs from achieving universal coverage in the areas where IRS is recommended in their national strategies (see figure). One example of questions PMI face is related to indoor residual spraying (IRS). To confront these challenges, and to try and outpace the ever-changing epidemiology of malaria, PMI supports operational research focused on how to improve uptake and scale-up of interventions cost-effectively implement combinations of interventions preserve the effectiveness of interventions in the face of insecticide and drug resistance and measure the success and impact of interventions. ![]() PMI operates in 27 countries across sub-Saharan Africa and the Greater Mekong Subregion and often during the course of program implementation, unforeseen obstacles and new questions emerge. Operational research is critically important to the success of the U.S. ![]()
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