Estimating the Effect of Indoor Residual Spraying on Maternal Mortality, Low-Birthweight and Perinatal Mortality Among HIV-Infected Pregnant Women Living in the HAART Era

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It is well known that children born to women co-infected with HIV and malaria are at increased risk of low birthweight and perinatal death. Preliminary work has shown that indoor residual spraying with insecticide, a well-known malaria control strategy, is associated with 50-71% reduction in low birthweight and 61-90% risk reduction in neonatal mortality among both HIV-infected women and HIV-uninfected women. While potentially important findings, the opportunistic before and after study design approach used is open to issues of confounding. Using a novel spatial difference-in-difference analysis, applied to data from a population in Uganda under a current UCSF study, we propose to estimate the real-world effectiveness of IRS in preventing maternal mortality and adverse birth outcomes among HIV-infected and uninfected women, and identify high-risk populations that would benefit most from IRS.