Extension of indoor residual spraying for malaria control into high transmission settings in Africa

Contrary to previous consensus, a recent WHO statement recommends a more dominant role for indoor residual spraying (IRS) in malaria control in high transmission settings of sub-Saharan Africa and re-emphasises the rote of DDT We review the issues related to this change in recommendation. In high transmission settings, IRS must be implemented indefinitely and at high quality to achieve control. As current infrastructure limitations and unpredictable funding make this unlikely, each country must carefully consider the rote of IRS. There remains a need to support ongoing insecticide-treated net scale-up. Insecticide choice is hampered by the lack of economic costing data. (c) 2007 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.