%D 2000 %0 ARTICLE %T Indoor residual spraying with alphacypermethrin controls malaria in Pakistan : a community-randomized trial %J Trop . Med . Int . Health %V 5 ( 7 ) %P 472-81 %A Rowland M %A Mahmood P %A Iqbal J %A Carneiro I %A Chavasse D %M pub10964269 %X We conducted a community-randomized controlled trial in Pakistan to determine the efficacy of indoor residual spraying with alphacypermethrin ( Fendona , Cyanamid , NJ , USA ) , applied at 25 mg/m2 , to prevent falciparum and vivax malaria . Wettable powder ( WP ) and suspension concentrate ( SC ) formulations were tested against an unsprayed control in an irrigated rice-growing area of Sheikhupura district , Punjab province . The study area of 180 km2 was divided into nine sectors , which were assigned at random to control , WP , or SC treatments in replicates of 3 . Sentinel villages were selected from each sector for entomological and disease monitoring . Malaria was monitored by fortnightly active case detection ( ACD ) and by cross sectional parasite surveys on schoolchildren . Mosquito populations were monitored by space spraying of rooms and by cattle-landing catches . The spray campaign took place in June 1997 and covered 96% of compounds . During the 7 months after spraying , the incidence of falciparum malaria was 95% lower and that of vivax malaria 80% lower in WP-sprayed than unsprayed sectors . Similar results were obtained for sectors sprayed with the SC formulation . Cross-sectional surveys gave estimates of efficacy comparable to those obtained by ACD . Anopheles culicifacies was 80% less abundant and Astephensi , the predominant anopheline , was up to 68% less abundant in sprayed areas over the 7-month period . Reductions in anopheline parous rates indicated that the single-spray treatment was effective for the entire transmission season . Sprayed surfaces lacked odour , which contributed to the popularity of the campaign . Alphacypermethrin is a promising insecticide for the control of malaria in Pakistan and South Asia generally .