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Impact of insecticide resistance in Anopheles arabiensis on malaria incidence and prevalence in Sudan and the costs of mitigation.


ABSTRACT: Insecticide-based interventions have contributed to ?78% of the reduction in the malaria burden in sub-Saharan Africa since 2000. Insecticide resistance in malaria vectors could presage a catastrophic rebound in disease incidence and mortality. A major impediment to the implementation of insecticide resistance management strategies is that evidence of the impact of resistance on malaria disease burden is limited. A cluster randomized trial was conducted in Sudan with pyrethroid-resistant and carbamate-susceptible malaria vectors. Clusters were randomly allocated to receive either long-lasting insecticidal nets (LLINs) alone or LLINs in combination with indoor residual spraying (IRS) with a pyrethroid (deltamethrin) insecticide in the first year and a carbamate (bendiocarb) insecticide in the two subsequent years. Malaria incidence was monitored for 3 y through active case detection in cohorts of children aged 1 to <10 y. When deltamethrin was used for IRS, incidence rates in the LLIN + IRS arm and the LLIN-only arm were similar, with the IRS providing no additional protection [incidence rate ratio (IRR) = 1.0 (95% confidence interval [CI]: 0.36-3.0; P = 0.96)]. When bendiocarb was used for IRS, there was some evidence of additional protection [interaction IRR = 0.55 (95% CI: 0.40-0.76; P < 0.001)]. In conclusion, pyrethroid resistance may have had an impact on pyrethroid-based IRS. The study was not designed to assess whether resistance had an impact on LLINs. These data alone should not be used as the basis for any policy change in vector control interventions.

SUBMITTER: Kafy HT 

PROVIDER: S-EPMC5748194 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Impact of insecticide resistance in <i>Anopheles arabiensis</i> on malaria incidence and prevalence in Sudan and the costs of mitigation.

Kafy Hmooda Toto HT   Ismail Bashir Adam BA   Mnzava Abraham Peter AP   Lines Jonathan J   Abdin Mogahid Shiekh Eldin MSE   Eltaher Jihad Sulieman JS   Banaga Anuar Osman AO   West Philippa P   Bradley John J   Cook Jackie J   Thomas Brent B   Subramaniam Krishanthi K   Hemingway Janet J   Knox Tessa Bellamy TB   Malik Elfatih M EM   Yukich Joshua O JO   Donnelly Martin James MJ   Kleinschmidt Immo I  

Proceedings of the National Academy of Sciences of the United States of America 20171211 52


Insecticide-based interventions have contributed to ∼78% of the reduction in the malaria burden in sub-Saharan Africa since 2000. Insecticide resistance in malaria vectors could presage a catastrophic rebound in disease incidence and mortality. A major impediment to the implementation of insecticide resistance management strategies is that evidence of the impact of resistance on malaria disease burden is limited. A cluster randomized trial was conducted in Sudan with pyrethroid-resistant and car  ...[more]

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