Vulnerability of Populations to Malaria after Indoor Residual Spraying is Withdrawn from Areas where its Use has Previously Been Sustained. Protocol for a Systematic Review
Authors: Orishaba Philip , Kayongo Edward , Lusiba Pastan , Nakalema Caroline , Kasadha Peter , Kiirya Perez , Kawooya Ismael , Mijumbi-Deve Rhona 
Published: May 2022

AbstractBackgroundWith its proven effectiveness, indoor residual spraying (IRS) as a malaria vector control strategy form one of the reliable vector control strategies, especially when at least 80% of the population is covered. However, to date, there is uncertainty regarding the consequences of IRS withdrawal on malaria control when there’s no clear exit strategy in place. Therefore, there is need to comprehensively update literature regarding malaria burden indicators when IRS is withdrawn following sustained use.MethodsThis protocol follows the PRISMA guidelines. We performed a systematic search of studies published between 2000 and 2022 in CINAHL, Embase, MEDLINE, ProQuest, PsychInfo, Scopus and OpenGrey. Using pre-set eligibility criteria, studies will be used to identify the relevant ones by two independent reviewers. Title/ abstracts will first be screened and potentially eligible ones screened using their full-text publications. Any conflicts/ discrepancies at the two stages will be resolved through regular discussion sessions. Included studies will be extracted to capture study & patient characteristics and relevant outcomes (malaria incidence and malaria vector abundance). Relevant tools will be used to assess the risk of bias in the studies measuring the impact of withdrawal. A meta-analysis will be performed, if sufficient homogeneity exists; otherwise, data arising will be presented using tables and by employing narrative synthesis techniques. Heterogeneity will be assessed using a combination of visual inspection of the forest plot along with consideration of the chi-square test and I-square statistic results.Ethics and disseminationEthics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations. Furthermore, this systematic review will inform the design of exit strategies for IRS-based programs in malaria endemic areas.PROSPERO registration numberCRD42022310655Strengths and limitations of this studyTo the strength of this study, we hope to produce the first systematic review of the impact of IRS withdrawal comprehensively. Such comprehension will be defined by including studies from different settings, among different age groups and studies assessing malaria burden indicators either among human populations or mosquito populations or both. This review also utilizes systematic and transparent rigorous procedures guided by the Cochrane handbook and will report results as stated by Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Furthermore, an experienced information specialist designed the search strategy and customized it to the different data bases that we intend to search. We anticipate some anticipations. In this systematic review, the certainty of the evidence could be limited by few numbers of publications and low quality of studies.