Abstract
BackgroundICON® Maxx (Syngenta) is an insecticide treatment kit of pyrethroid and binding agent for long-lasting treatment of mosquito nets. Interim recommendation for use on nets was granted by the World Health Organization (WHO) after successful evaluation in experimental huts following multiple washes. A full WHO recommendation is contingent upon demonstration of continued bio-efficacy after 3 years of use.MethodsA household-randomized prospective study design was used to assess ICON Maxx-treated nets over 3 years in north-eastern Tanzania. Conventional treated nets (with lambda-cyhalothrin, but without binder) served as a positive control. At 6-monthly intervals, cross-sectional household surveys monitored net use and physical integrity, while cone and tunnel tests assessed insecticidal efficacy. Pyrethroid content was determined after 12 and 36 months. A parallel cohort of nets was monitored annually for evidence of net deterioration and attrition.ResultsAfter 12 months’ use, 97% of ICON Maxx-treated nets but only 67% of CTN passed the WHO efficacy threshold for insecticidal durability (> 80% mortality in cone or tunnel or 90% feeding inhibition in tunnel). After 24- and 36-months use, 67% and 26% of ICON Maxx treated nets met the cone criteria, respectively, and over 90% met the combined cone and tunnel criteria. Lambda-cyhalothrin content after 36 months was 17% (15.8 ± 4.3 mg/m2) of initial content. ICON Maxx nets were used year-round and washed approximately 4 times per year. In cross-sectional survey after 36 months the average number of holes was 20 and hole index was 740 cm2 per net. Cohort nets had fewer holes and smaller hole index than cross-sectional nets. However, only 15% (40/264) of cohort nets were not lost to follow-up or not worn out after 36 months.ConclusionsBecause more than 80% of nets met the WHO efficacy criteria after 36 months use, ICON Maxx was granted WHO full recommendation. Cross-sectional and cohort surveys were complementary and gave a fuller understanding of net durability. To improve net usage and retention, stronger incentives and health messaging should be introduced in WHO LLIN longitudinal trials. Untreated polyester nets may be made long-lastingly insecticidal in Africa through simple household treatment using ICON Maxx pyrethroid-binder kits.
Highlights
ICON® Maxx (Syngenta) is an insecticide treatment kit of pyrethroid and binding agent for long-lasting treatment of mosquito nets
Highest numbers of Long-lasting insecticidal nets (LLINs) are being delivered to sub-Saharan countries, 1 in 4 children live in households with no access to insecticide-treated nets (ITNs) or protection by indoor residual spraying [3]
The main objective of the present study was to evaluate ICON Maxx treated nets in line with World Health Organization (WHO) guidelines for field testing of LLIN to determine insecticidal efficacy, wash fastness, acceptability, net integrity and net survivorship under East African household conditions over 3 years of use in comparison with a standard lambda-cyhalothrin 10% CS conventionally treated net without binder
Summary
ICON® Maxx (Syngenta) is an insecticide treatment kit of pyrethroid and binding agent for long-lasting treatment of mosquito nets. Long-lasting insecticidal nets (LLINs) are an important tool for malaria vector control. The proportion of the population with access to insecticide-treated nets (ITNs) and LLINs has increased markedly in sub-Saharan Africa over the past two decades. Manufacturers’ delivery data for 2004–2020 show that over 2.3 billion ITNs and LLINs were supplied globally in that period, of which 1.9 billion (86%) were supplied to sub-Saharan Africa [2]. Highest numbers of LLINs are being delivered to sub-Saharan countries, 1 in 4 children live in households with no access to ITN or protection by indoor residual spraying [3]. To achieve one LLIN for every two household members, a ratio considered sufficient to achieve universal coverage [4], an estimated 200–300 million replacement nets are required each year to achieve and maintain universal access [3]
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