In Uganda’s Bidibidi refugee settlement, one of the largest in the world, malaria is a daily reality. National malaria control efforts such as free insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are essential, but gaps in protection still exist.

Large households, open housing structures, and exposure during early morning or evening hours mean many families remain at risk.

As part of the Advancing Evidence for the Global Implementation of Spatial Repellents (AEGIS) project, researchers from the Johns Hopkins Center for Communication Programs and Catholic Relief Services  examined what mosquito control products are available in the retail markets and being purchased within the Bidibidi settlement area, home to more than 200,000 refugees –  mostly from South Sudan – and neighboring communities.

Their findings, published in Malaria Journal, highlight how communities themselves drive malaria prevention efforts to make deliberate choices to protect their households, even amid the challenges of displacement, by actively seeking out mosquito control tools and purchasing the products that best meet their needs.

“If we want malaria prevention tools to succeed, we need to pay attention to what people are already choosing for themselves,” said Kaci McCoy, the study’s lead author and former researcher at CCP. “Households in Bidibidi are choosing mosquito control tools that fit their lives, and retailers are very in tune with that demand.”

Uganda carries one of the world’s highest malaria burdens, and refugees experience an especially heavy toll. In Bidibidi, large household sizes, open housing structures, and gaps in net coverage mean that many people remain exposed to mosquitoes carrying the malaria parasite, particularly outside of sleeping hours when people are not under a mosquito net.

To better understand how communities fill those gaps, CCP and CRS led a retail audit across 61 refugee and host community villages, mapping 828 outlets and surveying 252 shopkeepers.

Nearly two-thirds of surveyed outlets were selling mosquito control products when the study was conducted from May to July 2024. The most commonly stocked item was insecticide-treated incense sticks – small, inexpensive products that are burned to repel mosquitoes.

Treated nets for adults followed, along with non-insecticidal incense sticks and mosquito coils. Many shops sold more than one product and restocked at least monthly, often sourcing supplies from nearby wholesalers in nearby Yumbe town.

Shopkeepers described a clear seasonal pattern. Sales surged during the rainy months, when mosquitoes were plentiful, and dipped during the dry season or shortly after government net distributions and spraying campaigns.

Despite this fluctuation, most sellers reported that mosquito control products were profitable and planned to continue stocking them.

Motivations for selling these products went beyond income. Many respondents pointed to a sense of responsibility and community benefit, describing malaria prevention as both good business and a social good.

As one refugee shop owner explained, selling mosquito control products allows people to “easily access, buy, and use” tools to protect themselves and their families.

Still, challenges persist. Limited capital was the most frequently cited barrier, particularly for higher-cost items like ITNs or aerosol sprays. Unreliable supply chains, lack of product knowledge, and concerns about storing insecticides alongside food products also discouraged some shopkeepers.

Yet even among outlets not currently selling mosquito control products, nearly half expressed interest in doing so in the future if these barriers could be addressed.

The findings arrive at a pivotal moment.

In 2025, the World Health Organization issued a conditional recommendation for spatial repellents as a complementary malaria control tool, based partly on the work of the AEGIS project, in which CCP was a partner. Products that protect people at times when indoor residual spraying or treated bed nets offer little protection or are not feasible, such as spatial repellents and other mosquito control products found on the retail market, may be especially relevant in humanitarian contexts.

“This study helps us see where and how new tools might realistically fit,” McCoy said. “The retail patterns in Bidibidi tell us a lot about real-world needs, and real-world solutions.”

Perhaps the most important takeaway is one of agency. People are actively managing their own malaria risk, even in a setting with limited resources, and they are turning to familiar retail spaces to reduce risk, the researchers say.

“Malaria control in humanitarian settings has long focused on what can be delivered. This research suggests equal value in understanding what is already being purchased and why,” says CCP’s Danielle Piccinini Black, who served as the methodology lead. “Listening to shopkeepers and consumers alike may be key to building more effective, complementary malaria prevention strategies for the future.”

“A retail audit of mosquito control products in Bidibidi refugee settlement, northwestern Uganda” was written by Kaci D. McCoy, Esther Nakyaze, Samantha W. Tsang, Amy A. Ellis, Mary Grace Alwano, Olive D’Mello, Suzanne Van Hulle, Steve A Harvey, Danielle Piccinini Black and Jarvice Sekajja.