Evaluating indoor residual spray for reducing malaria infection prevalence in Eritrea: Results from a community randomized control trial

► Malaria parasite infection prevalence was 0.5%. ► ITN possession remains high, with over 70% of households reporting ITN ownership. ► ITN use among individuals within ITN-owning households was just under half. ► Community participation in environmental and larval habitat management activities was low. ► It is likely that IRS, larval habitat management and ITN distribution alone may be insufficient to interrupt transmission without corresponding high ITN use, sustained IRS application in areas where infections are clustered, and promptly seeking laboratory diagnosis and treatment of all fevers. ► Eritrea is ready for elimination, irrespective of inconclusive impact evaluation results.