A pilot implementation study of a community-led integrated malaria elimination model in Busoga, Uganda: protocol for a mixed-methods implementation research study

Introduction Malaria remains one of the leading public health challenges globally, with over 95% of the disease burden occurring in sub-Saharan Africa (SSA). In 2023, approximately 263 million malaria cases and 597,000 deaths were reported worldwide, most of them in Africa. Uganda continues to experience a high burden of malaria, particularly in transmission hotspots such as the Busoga sub-region in Eastern Uganda, where children under five years and pregnant women are disproportionately affected. Although proven interventions, including insecticide-treated nets, indoor residual spraying, intermittent preventive treatment during pregnancy, effective case management, and malaria vaccination, have been widely implemented, malaria remains a leading cause of morbidity and mortality among young children. This persistence reflects gaps in community uptake, behavioral factors, and challenges in implementing interventions effectively within local contexts. To address these challenges and contribute to the achievement of Sustainable Development Goal (SDG) 3.2 and related development goals, this study will pilot and assess a community-led integrated malaria elimination model in Nawanyingi sub-county, Iganga District, Uganda. Methods The study will employ a mixed-methods implementation research design guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. A prospective pre- and post-implementation approach will be used to evaluate the feasibility, acceptability, implementation processes, and preliminary outcomes of the intervention. The model comprises four integrated components: community engagement and mobilization, indoor and outdoor residual spraying (IRS/ORS) combined with larviciding, modified mass testing and treatment (MMTaT), and strengthened malaria surveillance and reporting through existing community and health system structures. Data will be collected during formative, implementation, and evaluation phases using household surveys, key informant interviews, focus group discussions, in-depth interviews, vector surveillance, District Health Information System 2 (DHIS2) data abstraction, and implementation monitoring tools. Changes in malaria transmission dynamics will be assessed through routine mosquito density monitoring and entomological observations. Quantitative data will be entered using Epi Info and analyzed using STATA version 17, while qualitative data will undergo thematic content analysis to identify implementation experiences, barriers, facilitators, and sustainability considerations. Ethics and dissemination Ethical approval will be obtained from a recognised Research and Ethics Committee in Uganda. Findings will be disseminated through peer-reviewed publications, stakeholder workshops, policy briefs, scientific conferences, and community feedback meetings. Lessons generated on feasibility, acceptability, and implementation challenges will inform for future scale-up and adaptation of the integrated malaria elimination model in similar high-burden settings.