Outcome Timeframe	Study results and measurements	Comparator No IRS	Intervention IRS	Certainty of the evidence (Quality of evidence)	Summary
(children under 5) (nRCT and controlled before-and-after data) follow-up: range 6-12 months	(Observational (non-randomized))	IRS. The risk of malaria infection in the sprayed group relative to the unsprayed group was 0.28 (95% CI: 0.10–0.77). Mashauri examined participants for malaria infection six months post-IRS. The risk of malaria infection was 0.19 (95% CI: 0.07–0.48) for those in the sprayed group compared to those in the unsprayed group.		risk of bias 6	of IRS on malaria prevalence in children under 5 years of age compared to no IRS when followed up from six months to 12 months.
Malaria, point prevalence (children 5-15 years) follow-up: range 3-6 months	Based on data from 2,752 participants in 2 studies. (Randomized controlled)	Curtis examined children over 6 years of age approximately three months post-IRS (first quarter of 1996, spraying in December 1995). The risk of malaria infection in the sprayed cohort relative to the unsprayed cohort was 1.10 (95% CI: 0.94–1.29). Rowland examined children between 5 and 15 years of age three months post-IRS. The risk of malaria infection in the sprayed cohort relative to the unsprayed cohort was 0.15 (95% CI: 0.06–0.37).		Very low Due to serious risk of bias, Due to serious inconsistency, Due to serious imprecision 7	The evidence is very uncertain about the effect of IRS on malaria prevalence in children aged 5 to 15 years compared to no IRS when followed up from three months to six months.
Malaria, point prevalence (children aged 5-15 years) (nRCT and controlled before-and-after data) follow-up: range 6-12 months	Based on data from 907 participants in 2 studies. (Observational (non-randomized))	Guyatt tested participants for malaria infection approximately two months after IRS. The risk of malaria infection in the sprayed group relative to the unsprayed group was 0.32 (95% CI: 0.19–0.55). Mashauri examined participants for malaria infection six months post-IRS. The risk of malaria infection was 0.60 (95% CI: 0.42–0.87) for those in the sprayed group compared to those in the unsprayed group.		Very low Due to very serious risk of bias, Due to serious imprecision 8	The evidence is very uncertain about the effect of IRS on malaria prevalence in children aged 5 to 15 years compared to no IRS when followed up from six months to 12 months.
Malaria, point prevalence (aged 15+ years) (nRCT and controlled before-and-after data) follow-up: range 6-12 months	Based on data from 916 participants in 2 studies. (Observational (non-randomized))	Guyatt tested participants for malaria infection approximately two months after IRS. The risk of malaria infection in the unsprayed group relative to the unsprayed group was 0.17 (95% CI: 0.07–0.43). Mashauri examined participants for malaria infection six months post-IRS. The risk of malaria infection was 1.26 (95% CI: 0.57–2.76) for those in the sprayed group compared to those in the unsprayed group.		Very low Due to very serious risk of bias, Due to serious imprecision 9	The evidence is very uncertain about the effect of IRS on malaria prevalence in those aged 15 years or older compared to no IRS when followed up from six months to 12 months.
Death, incidence rate (children under 5 years) follow-up: mean 3 months	Based on data from 2,000 participants in 1 studies. (Randomized controlled)	There were no deaths in children under 5 years in the treated camps within three months following IRS. Confidence intervals could not be estimated.		Very low Due to serious risk of bias, Due to serious indirectness, Due to serious imprecision 10	The evidence is very uncertain about the effect of IRS on all-cause deaths in children under 5 years of age compared to no IRS when followed up for 3 months.

This Comparison Chart consists of three vertically aligned line graphs illustrating the relationship between air quality and human health risk over a study period from March 2015 to April 2017. The top panel displays the Air Quality Index (AQI), with values ranging from 0 to 450. The middle panel shows the Total Relative Risk (RRTotal), a clinical epidemiological measure of health hazard, fluctuating between 1.050 and 1.275. The bottom panel presents the Health-based Air Quality Index (HAQI), scaled from 0 to 840. Visually, all three curves demonstrate high synchronicity, exhibiting marked seasonal fluctuations characterized by peaks in winter months (notably December 2015 and December 2016) and valleys during summer months. The graph serves as a public health visualization tool to demonstrate how air pollution levels (AQI/HAQI) correlate with short-term clinical health risks (RRTotal). This content is relevant to environmental health, respiratory medicine, and medical epidemiology, illustrating the impact of environmental factors on population health outcomes.

Evidentiary Table. (continued) <table><thead><tr><th>Author & Year Published</th><th>Class of Evidence</th><th>Setting & Study Design</th><th>Methods & Outcome Measures</th><th>Results</th><th>Limitations & Comments</th></tr></thead><tbody><tr><td>Kerber et al⁸² (2015)</td><td>III for Q4</td><td>Prospective cohort study at 1 center in Michigan; the target population was patients presenting for acute dizziness without an obvious cause who also had examination findings (ie, nystagmus [spontaneous or gaze-evoked] or imbalance when walking) that could be attributable to neurologic dysfunction</td><td>Evaluated the ability of the combination of bedside predictors of stroke—including both the ABCD2 score and the specialized OM examination-to stratify stroke risk using an MRI-based industry standard; study examinations were performed before the MRI whenever possible or blinded to the results of the MRI; OM examination was performed including a nystagmus assessment, assessment of skew deviation, and the head impulse test; primary outcome was an imaging-based definition of stroke, specifically any acute infarction or ICH on MRI as determined by a neuroradiologist</td><td>N=320 patients; stroke rate 11% in multivariable logistic regression models, ABCD2 OR 1.74 (95% CI 1.20 to 2.5); HINTS positive OR 2.82 (95% CI 0.96 to 8.30); false-negative frequency (ie, frequency of stroke in the lowest-risk categories) was as follows: ABCD2 <4, 5.1% (8/157); OM assessment, 5.9% (9/152) (4.9% [4/82], for HINTS peripheral findings); other CNS features, 7.8% (17/219); and prior stroke, 10.8% (28/260); the OM assessment was positive for a central lesion in 20 of the 29 stroke patients (69%); of the 9 stroke patients who did not have the central OM findings, 7 patients were in the no-nystagmus category (5) and/or had an acute infarction that was possibly incidental (3)</td><td>15% did not receive MRI within 14 d; physical examination was performed in a structured fashion by a study investigator, either a neurologist fellowship trained in neuro-otology or vascular neurology, or an emergency medicine physician fellowship trained in vascular neurology—not generalizable to the general EM professional population</td></tr></tbody></table>