Pilgrim Africa was honored to be a part of the first-ever Public-Private-Partnership (PPP) for indoor residual spraying (IRS) in five urban slums of Kampala District, Uganda, carried out in January 2022. As part of the PPP IRS pilot, Pilgrim Africa (PA) conducted a community-based survey in children 15 years 
and under in both PPP-sprayed and unsprayed urban slums.
Collaborating closely with the Kampala Capital City Authority (KCCA) and the National Malaria Control Division (NMCD), the PA team engaged 16 village health teams and 8 local councils to enumerate all households in 5 sprayed and 2 unsprayed parishes prior to survey implementation. A total of 400 households were randomly selected from each strata to participate in the survey, which consisted of a household questionnaire, a caretaker’s questionnaire and a malaria biomarker assessment using rapid diagnostic test (RDT) to test and treat children 15 years and under in the household.
From April 22nd – May 7th, 2022, interviewers surveyed a total of 738 households, 731 caretakers and assessed 1,212 children 0–15 years of age.
The community-based survey found that malaria in slum dwellers in unsprayed homes is 7 times higher than it estimated for city residents on average. The survey also revealed significant housing and environmental deficiencies that expose residents to mosquitoes, and also serve as breeding and habitat sites for malaria mosquitoes. Roughly 50% of households in both PPP-IRS and unsprayed parishes reported feeling unprotected from mosquito biting while at home, and 70% feel their environment (i.e. the stagnant water, sewage and drainage) is the cause. While only a small proportion of households use mosquito repellent (6%) or mosquito coils (5%), almost 40% of households dry out puddles and stagnant water around their house.
Though IRS is a highly effective intervention in high burden malaria areas, it may not be the stand-alone intervention for urban settings, where the surrounding environment continues to breed malaria mosquitoes. Results from this survey can help inform a multipronged approach for urban settings. A combined public-private partnership with community engagement can support malaria prevention and control in a largely ignored and vulnerable population.