Study interventions and arm assignment
treatmemt, Toroma
This study had two main study interventions, IRS with pirimiphos methyl (Actellic 300 CS, Syngenta) and MDA with DP (Eurartesim, Sigma Tau). Population-wide IRS was conducted four times in two arms by the research team, spaced by roughly 8 months. In one of the arms, a single treatmemt dose of population-wide MDA was administered and co-timed with each IRS spray round.IRS was conducted using Actellic 300 CS, a WHO recommended non-pyrethroid insecticide formulation of an existing organophosphate insecticide, pirimiphos-methyl, safe in use for humans and the environment and recommended by the WHO pesticide evaluations scheme (WHOPES) risk assessment [The study site with mapped households and arm assignments. Katakwi district on a map of Uganda, with an inset map showing the study area bordering Lake Bisina. The points on the inset map show geolocated households in 85 villages, color coded by adjacent intervention arms: green for Arm A with MDA + IRS, blue for Arm B with IRS, red for Arm C, standard of care. All sites have ITNs, case management, and IPTp which constitutes standard of careFlow chart of study intervention implementationThe three contiguous sub-counties, shown in Fig. Arm A (Kapujan sub county): 4 rounds of MDA with DP (Eurartesim) + IRS with pirimiphos methyl (Actellic) + SOC.Arm B (Toroma sub county): 4 rounds of IRS with pirimiphos methyl (Actellic) + SOC.Arm C (Magoro sub county): SOC only, including ITNs distributed through universal coverage campaign, case management at facilities, and intermittent treatment of pregnant women IPTp.